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

Pandolfino, John E.; Kim, Hyon; Ghosh, Sudip Kumar; Clarke, John O.; Zhang, Qing; Kahrilas, Peter J.

doi:10.1111/j.1572-0241.2007.01138.x

Cited by 252 publications

(257 citation statements)

References 14 publications

Supporting

Mentioning

238

Contrasting

Unclassified

Order By: Relevance

“…By utilizing many closely spaced manometric pressure sensors and interpolating between adjacent sensors, the axial pressure profile with the EGJ can be visualized in real time. Evident in Figure 9, this facilitates the localization and quantification of the crural diaphragm contraction within the EGJ [20,21]. In the normal individual (type I) the crural diaphragm effect is directly superimposed on the LES resulting in substantial pressure augmentation during respiration, the extremes of which are illustrated in the spatial pressure variation plots in the lower panels.…”

Section: The Manometric Assessment Of Sliding Hiatal Herniamentioning

confidence: 97%

“…Using high resolution manometry with topographic plotting, three major subtypes of EGJ pressure morphology are demonstrable (Figures 9 and 10): type I with the crural diaphragm completely superimposed on the LES, type II with 1-2 cm separation between the two, and type III with greater than 2 cm separation. In a recent analysis, it was noted that EGJ type III was rarely found in asymptomatic controls or functional heartburn patients but was a frequent finding in GERD patients demonstrating the clinical significance to this diagnostic approach [21].…”

Section: The Manometric Assessment Of Sliding Hiatal Herniamentioning

confidence: 99%

See 1 more Smart Citation

Approaches to the diagnosis and grading of hiatal hernia

Kahrilas

Kim

Pandolfino

2008

Best Practice & Research Clinical Gastroenterology

Self Cite

384

248

View full text Add to dashboard Cite

Hiatus hernia refers to conditions in which elements of the abdominal cavity, most commonly the stomach, herniate through the esophageal hiatus into the mediastinum. With the most common type (type I or sliding hiatus hernia) this is associated with laxity of the phrenoesophageal membrane and the gastric cardia herniates. Sliding hiatus hernia is readily diagnosed by barium swallow radiography, endoscopy, or manometry when greater than 2 cm in axial span. However, the mobility of the esophagogastric junction precludes the reliable detection of more subtle disruption by endoscopy or radiography. Detecting lesser degrees of axial separation between the lower esophageal sphincter and crural diaphragm can only be reliably accomplished with high resolution manometry, a technique that permits real time localization of these esophagogastric junction components without swallow or distention related artifact.

show abstract

Section: The Manometric Assessment Of Sliding Hiatal Herniamentioning

confidence: 97%

Section: The Manometric Assessment Of Sliding Hiatal Herniamentioning

confidence: 99%

Approaches to the diagnosis and grading of hiatal hernia

Kahrilas

Kim

Pandolfino

2008

Best Practice & Research Clinical Gastroenterology

Self Cite

384

248

View full text Add to dashboard Cite

show abstract

“…EGJ was classified depending on the separation between the LES and crural diaphragm: type I (normal) ＜ 1 cm, type II be-tween 1-2 cm, and type III (hiatal hernia) when the distance is over 2 cm. 5,19 End expiratory EGJ pressure was measured while at rest in both positions. Four seconds integrated relaxation pressure (IRP-4s) was measured using the automated analysis tool in Mano View.…”

Section: Discussionmentioning

confidence: 99%

How the Body Position Can Influence High-resolution Manometry Results in the Study of Esophageal Dysphagia and Gastroesophageal Reflux Disease

Ciriza-de-los-Ríos

Rodríguez-Valcárcel

Lora-Pablos

et al. 2015

J Neurogastroenterol Motil

View full text Add to dashboard Cite

Background/AimsThe body position can influence esophageal motility data obtained with high-resolution manometry (HRM). To examine whether the body position influences HRM diagnoses in patients with esophageal dysphagia and gastroesophageal reflux disease (GERD).Methods HRM (Manoscan) was performed in 99 patients in the sitting and supine positions; 49 had dysphagia and 50 had GERD assessed by 24-hour pH monitoring. HRM plots were analyzed according to the Chicago classification. ResultsHRM results varied in the final diagnoses of the esophageal body (EB) in patients with dysphagia (P = 0.024), the result being more distal spasm and weak peristalsis while sitting. In patients with GERD, the HRM diagnoses of the lower esophageal sphincter (LES), the esophagogastric junction (EGJ) morphology, and EB varied depending on the position; (P = 0.063, P = 0.017, P = 0.041 respectively). Hypotensive LES, EGJ type III (hiatal hernia), and weak peristalsis were more frequently identified in the sitting position. The reliability (kappa) of the position influencing HRM diagnoses was similar in dysphagia and GERD ("LES diagnosis": dysphagia 0.32 [0.14-0

show abstract

“…From a manometric point of view, three subtypes of EGJ have been described according to their morphology: subtype I (LES and overlapping DC), subtype II (separation between the LES and CD < 2 cm), and subtype III or hiatal hernia (separation between EGJ and CD > 2 cm). This latter subtype is in turn subdivided into IIIa and IIIb (55). The degree of disruption of the EGJ influences the pattern of GER (56).…”

Section: Current Situationmentioning

confidence: 99%

“…Other possible parameters are being evaluated such as inspiratory increase (55), integral LES pressure (58), the contractile integral of the EGJ (59) and the valuation of intragastric pressure (60).…”

Section: Current Situationmentioning

confidence: 99%

Practical aspects of high resolution esophageal manometry

Juan¹,

Ríos²,

Bueno³

et al. 2016

Rev Esp Enferm Dig

View full text Add to dashboard Cite

High resolution esophageal manometry (HRM) is currently under development as can be seen in the various Chicago classifications. In order to standardize criteria in certain practical aspects with limited scientific evidence, the First National Meeting for Consensus in High Resolution Manometry of the Spanish Digestive Motility Group took place, bringing together a wide group of experts. The proposals were based on a prior survey composed of 47 questions, an exhaustive review of the available literature and the experience of the participants. Methodological aspects relating to the poorly defined analysis criteria of certain new high resolution parameters were discussed, as well as other issues previously overlooked such as spontaneous activity or secondary waves. Final conclusions were drawn with practical applications.

show abstract

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

Cited by 252 publications

References 14 publications

Approaches to the diagnosis and grading of hiatal hernia

Approaches to the diagnosis and grading of hiatal hernia

How the Body Position Can Influence High-resolution Manometry Results in the Study of Esophageal Dysphagia and Gastroesophageal Reflux Disease

Practical aspects of high resolution esophageal manometry

Contact Info

Product

Resources

About