scholarly journals Management of Ineffective Esophageal Hypomotility

2021 ◽  
Vol 12 ◽  
Author(s):  
Sawangpong Jandee ◽  
Annelies Geeraerts ◽  
Hannelore Geysen ◽  
Nathalie Rommel ◽  
Jan Tack ◽  
...  
Keyword(s):  
Esophageal Motility ◽  
Clear Understanding ◽  
Smooth Muscle Contractility ◽  
Motility Disorders ◽  
High Resolution Manometry ◽  
Ineffective Esophageal Motility ◽  
Beneficial Effects ◽  
Prokinetic Agents ◽  
Number Of Patients ◽  
Complex Correlation

Esophageal hypomotility in general and especially ineffective esophageal motility according to the Chicago criteria of primary motility disorders of the esophagus, is one of the most frequently diagnosed motility disorders on high resolution manometry and results in a large number of patients visiting gastroenterologists. Most patients with esophageal hypomotility present with gastroesophageal reflux symptoms or dysphagia. The clinical relevance of the motility pattern, however, is not well established but seems to be correlated with disease severity in reflux patients. The correlation with dysphagia is less clear. Prokinetic agents are commonly prescribed as first line pharmacologic intervention to target esophageal smooth muscle contractility and improve esophageal motor functions. However, the beneficial effects of these medications are limited and only confined to some specific drugs. Serotonergic agents, including buspirone, mosapride and prucalopride have been shown to improve parameters of esophageal motility although the effect on symptoms is less clear. Understanding on the complex correlation between esophageal hypomotility and esophageal symptoms as well as the limited evidence of prokinetic agents is necessary for physicians to appropriately manage patients with Ineffective Esophageal Motility (IEM).

scholarly journals A pictorial presentation of 3.0 Chicago Classification for esophageal motility disorders

2016 ◽  
Vol 14 (3) ◽  
pp. 439-442 ◽  
Author(s):  
Fernando Augusto Herbella ◽  
Priscila Rodrigues Armijo ◽  
Marco Giuseppe Patti
Keyword(s):  
High Resolution ◽  
Esophageal Motility ◽  
Esophagogastric Junction ◽  
Esophageal Motility Disorders ◽  
Motility Disorders ◽  
High Resolution Manometry ◽  
Ineffective Esophageal Motility ◽  
Chicago Classification ◽  
Esophageal Spasm ◽  
Pictorial Presentation

ABSTRACT High resolution manometry changed several esophageal motility paradigms. The 3.0 Chicago Classification defined manometric criteria for named esophageal motility disorders. We present a pictorial atlas of motility disorders. Achalasia types, esophagogastric junction obstruction, absent contractility, distal esophageal spasm, hypercontractile esophagus (jackhammer), ineffective esophageal motility, and fragmented peristalsis are depicted with high-resolution manometry plots.

scholarly journals How to Cope with Big Data in Functional Analysis of the Esophagus

2020 ◽  
Vol 36 (6) ◽  
pp. 439-442
Author(s):  
Alissa Jell ◽  
Christina Kuttler ◽  
Daniel Ostler ◽  
Norbert Hüser
Keyword(s):  
Esophageal Motility ◽  
Learning Algorithm ◽  
Supervised Machine Learning ◽  
Esophageal Motility Disorders ◽  
Motility Disorders ◽  
High Resolution Manometry ◽  
Evaluation Time ◽  
Core Evaluation

<b><i>Introduction:</i></b> Esophageal motility disorders have a severe impact on patients’ quality of life. While high-resolution manometry (HRM) is the gold standard in the diagnosis of esophageal motility disorders, intermittently occurring muscular deficiencies often remain undiscovered if they do not lead to an intense level of discomfort or cause suffering in patients. Ambulatory long-term HRM allows us to study the circadian (dys)function of the esophagus in a unique way. With the prolonged examination period of 24 h, however, there is an immense increase in data which requires personnel and time for evaluation not available in clinical routine. Artificial intelligence (AI) might contribute here by performing an autonomous analysis. <b><i>Methods:</i></b> On the basis of 40 previously performed and manually tagged long-term HRM in patients with suspected temporary esophageal motility disorders, we implemented a supervised machine learning algorithm for automated swallow detection and classification. <b><i>Results:</i></b> For a set of 24 h of long-term HRM by means of this algorithm, the evaluation time could be reduced from 3 days to a core evaluation time of 11 min for automated swallow detection and clustering plus an additional 10–20 min of evaluation time, depending on the complexity and diversity of motility disorders in the examined patient. In 12.5% of patients with suggested esophageal motility disorders, AI-enabled long-term HRM was able to reveal new and relevant findings for subsequent therapy. <b><i>Conclusion:</i></b> This new approach paves the way to the clinical use of long-term HRM in patients with temporary esophageal motility disorders and might serve as an ideal and clinically relevant application of AI.

P173 HIGH-RESOLUTION MANOMETRIC FINDINGS AFTER MAGNETIC SPHINCTER AUGMENTATION

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Carlo Galdino Riva ◽  
Stefano Siboni ◽  
Veronica Lazzari ◽  
Marco Sozzi ◽  
Emanuele Asti ◽  
...  
Keyword(s):  
High Resolution ◽  
Esophageal Motility ◽  
Symptom Relief ◽  
Rank Test ◽  
Barium Swallow ◽  
Upper Gastrointestinal Endoscopy ◽  
Magnetic Sphincter Augmentation ◽  
Hrql Score ◽  
High Resolution Manometry ◽  
Ineffective Esophageal Motility

Abstract Aim The aim of this study was to evaluate esophageal motility before and after Magnetic Sphincter Augmentation (MSA) for medically refractory Gastro-Esophageal Reflux Disease (GERD). Background and Methods MSA (LINX® Reflux Management System) is intended for patients with chronic GERD with incomplete symptom relief from proton-pump inhibitors (PPI) and abnormal acid exposure. A prospectively collected database of patients who underwent MSA between 2007 and 2019 was queried. All patients who completed pre- and post-operative high-resolution manometry (HRM) were included in the study. Additional investigations included Health-Related Quality of Life (GERD-HRQL) questionnaire, Functional Outcome Swallowing Scale (FOSS), upper gastrointestinal endoscopy, barium swallow, and 24-96 hours pH-study. Data were analyzed using Wilcoxon signed rank test and McNemar test. Results Forty-five patients met the inclusion criteria. The median follow-up was 10 months (IQR 6). Compared to baseline, there was a statistically significant reduction in PPI use (p=0.000), rate of heartburn (p=0.000), regurgitation (p=0.008), and extra-esophageal symptoms (p=0.000). Only three (6.7%) patients required dietary changes. The GERD-HRQL score significantly improved (p=0.000). There was a significant increase in the Lower Esophageal Sphincter (LES) competency, including LES length (p=0.004) and Esophago-gastric Contractile Integral ((EGJ-CI) (p=0.000). A significant increase in integrated relaxation pressure (IRP) (p=0.000), mean Distal Contractile Integral (DCI) (p=0.008) and intrabolus pressure (p=0.000) was also found. Thirteen (28.9%) patients presented pre-operative Ineffective Esophageal Motility (IEM) and five of them resolved postoperatively. Two patients (4.4%) developed IEM after surgery: both had IRP and DCI values within normal limits, and one of them complained of dysphagia. However, the GERD-HRQL score recovered in both patients. Conclusion MSA was clinically effective in relieving both typical and atypical GERD symptoms. LES competency increased after MSA. EGJ outflow obstruction was uncommon and not associated with symptoms. Finally, ineffective esophageal motility may reverse to normal after MSA.

Tu1412 IMPACT OF INEFFECTIVE ESOPHAGEAL MOTILITY ON SECONDARY PERISTALSIS IN GERD: STUDIES WITH HIGH RESOLUTION MANOMETRY

2020 ◽  
Vol 158 (6) ◽  
pp. S-1095-S-1096
Author(s):  
Wei-Yi Lei ◽  
Jen-Hung Wang ◽  
Ming-Wun Wong ◽  
Chih-Hsun Yi ◽  
Tso-Tsai Liu ◽  
...  
Keyword(s):  
High Resolution ◽  
Esophageal Motility ◽  
High Resolution Manometry ◽  
Ineffective Esophageal Motility ◽  
Secondary Peristalsis

P57 MOTILITY DISORDERS OF THE ESOPHAGUS - A RISK FACTOR FOR THE DEVELOPMENT OF BARRETT'S ESOPHAGUS?

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Knepper Laura ◽  
Bär Anne-Kathrin ◽  
Müller Dolores ◽  
Fuchs Hans ◽  
Fuchs Claudia ◽  
...  
Keyword(s):  
Barrett’S Esophagus ◽  
Esophageal Motility ◽  
Barrett's Esophagus ◽  
Demographic Data ◽  
Motility Disorders ◽  
High Resolution Manometry ◽  
Demeester Score ◽  
Basal Pressure ◽  
Patient Groups ◽  
The Mean

Abstract Aim This study aims to investigate the extent to which esophageal motility affects the development and progression of Barrett's mucosa in GERD patients. Background and Methods The Barret´s esophagus is becoming even more important against the background of an increasing incidence of adenocarcinoma of the esophagus1. The question as to why only a few patients with gastroesophageal reflux disease (GERD) develop a Barrett's esophagus has not been clarified. A cohort of 315 GERD patients with and without Barrett's esophagus who received High Resolution Manometry (HRM) as part of their regular diagnostics was therefore examined in this study. The evaluation of the HRM results was based on the Chicago classification version 3.02 and was compared with endoscopic and histological findings. Results Out of the 315 GERD patients, 67 had a Barrett's esophagus. The two patient groups (GERD without Barrett and GERD with Barrett) did not differ in demographic data and risk profile (hiatal hernia 71.4% vs 10.2%). In pH metry, both groups achieved a comparable DeMeester score as well as a similar fraction time (49.6 vs 44.2, 13% vs 11.7%). In both groups, approximately 40% of patients showed motility disorders. The mean basal pressure and the mean DCI also showed comparable values (21.2 vs 21.3, 1189.2 vs 1249.2). However, when comparing patients within the Barrett cohort with a long and a short segment Barrett (LSB, SSB), differences in peristalsis and pressure build-up of the distal esophagus become clear. Patients with an LSB showed a lower basal pressure of the lower esophageal sphincter (LES) and lower mean DCI (12.9 vs 25.0, 1230.0 vs 1389.3). In addition, they presented a hypotonic LES more frequently (54.6% vs 17.4%). Patients with LSB also showed motility disorders more often (54.6 vs 39.1), especially ineffective motility and fragmented peristalsis (18.2% vs 10.9%, 9.1% vs 2.2%). Conclusion The differences in motility disorders between Barrett and non-Barrett patients already described in other publications3 could not be confirmed in this study, despite the large cohort of 315 patients. However, the differences between LSB and SSB patients suggest that esophageal motility disorders can at least influence the severity of this disease.

scholarly journals High-Resolution Manometry Correlates of Ineffective Esophageal Motility

2012 ◽  
Vol 107 (11) ◽  
pp. 1647-1654 ◽  
Author(s):  
Yinglian Xiao ◽  
Peter J Kahrilas ◽  
Mary J Kwasny ◽  
Sabine Roman ◽  
Zhiyue Lin ◽  
...  
Keyword(s):  
High Resolution ◽  
Esophageal Motility ◽  
High Resolution Manometry ◽  
Ineffective Esophageal Motility
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