BACKGROUND Oesophageal motility classification using high resolution manometry (HRM) has been established in the supine position. Nevertheless, examination in the sitting position is more physiological. Our aim was to determine if body position modifies oesophago-gastric junction (OGJ) morphology and oesophageal motility. METHODS A total of 100 patients (47 males, mean age 51 years) were included in this study. The oesophageal HRM protocol included examination in supine and sitting positions. Recordings were reviewed by two different operators. Amplitude, duration, velocity, Distal Contractile Integral (DCI) and Pressurization Front Velocity of oesophageal waves induced by swallowing were recorded. KEY RESULTS The lower oesophageal sphincter resting pressure was not significantly changed by body position. The sitting position modified the OGJ classification in 12 patients. The inter-observer agreement to classify OGJ was moderate (kappa = 0.54 and 0.46, in the supine and sitting positions respectively) while it was good to diagnose motility disorders (kappa = 0.72 and 0.83). The percentage of normal waves was lower in the sitting position in comparison with the supine position (56%vs 67%, P < 0.01). The DCI was also lower in the sitting position (1125 mmHg.s.cm vs 1639, P < 0.01) as well as the amplitude of oesophageal waves. Finally the diagnosis was concordant in both positions in 72 patients. CONCLUSIONS & INFERENCES Body position can affect OGJ morphology and oesophageal motility assessment by HRM in some patients. Normal values in the sitting position should thus be determined. Inter-observer variation for the proposed classification of OGJ morphology must also be taken into account.
We failed to demonstrate any benefit of TENS on our primary end-point.
PURPOSE: Despite frequent occurrence, functional defecation disorders and related conditions have been infrequently reported in population studies. This study was designed to assess symptoms, lifestyle-behavioral changes, and medical care seeking related to functional defecation disorders in a large household community survey. METHODS: A large household community survey was conducted in 10,000 individuals aged 15 years or older. A mailed questionnaire was used to assess ten common anorectal complaints; frequency, association, impact on quality of life, and medical care seeking were quantified. RESULTS: Evaluation was obtained in 7,196 patients (3,455 males). During the previous 12-month period, 2,097 patients (29.1 percent) experienced functional defecation disorders: outlet constipation and fecal incontinence were reported in 22.4 and 16.8 percent respectively. Compared with patients with no anorectal complaint, patients with functional defecation disorders had a different gender status (females, 63.3 vs. 47.6 percent; P < 0.01). Based on symptom severity, functional defecation disorders were perceived as the main anorectal complaint in 1,192 patients. In this group, emptying difficulties, unsatisfied defecation, gas, and fecal incontinence occurred at least once per month in 71.6, 56.1, 77.9, and 49 percent respectively: 66.6 percent with outlet constipation and 85.6 percent with incontinence revealed impairment in quality of life. Incontinent patients more frequently avoided medical care than those complaining of outlet constipation (67.4 vs. 46.4 percent; P < 0.01). CONCLUSIONS: Functional defecation disorders concerns at least one of four French individuals. Outlet constipation and fecal incontinence frequently occur in association. Despite a low rate of patients seeking care, symptoms often are severe and related to quality of life impairment. [
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