Manometric and symptomatic spectrum of motor dysphagia in a tertiary referral center in northern India

Misra, Asha; Chourasia, Dipti; Ghoshal, Uday C

doi:10.1007/s12664-010-0002-7

Cited by 17 publications

(15 citation statements)

References 22 publications

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“…26,27,29 Body motility, distal contractile integral and integrated relaxation pressure (IRP) were evaluated in response to 10 water swallows (5 mL each) according to standard methods. 27 Patients were classified either into classic or vigorous types with conventional manometry.…”

Section: Diagnosis and Sub-typing Of Achalasiamentioning

confidence: 99%

“…27 Patients were classified either into classic or vigorous types with conventional manometry. 29 On HRM, achalasia was classified into type I, type II, and type III as per Chicago classification. 28 In the earlier classification, patients with achalasia with low amplitude contractions in the body (average amplitude ≤ 40 mmHg) were classified as classic achalasia.…”

Section: Diagnosis and Sub-typing Of Achalasiamentioning

confidence: 99%

“…Those with high amplitude contractions in the esophageal body (average amplitude > 40 mmHg), either focal segmental or diffuse, were classified as vigorous achalasia. 29 In the current Chicago classification, those with low amplitude contraction in the body as represented by no distal esophageal pressurization of > 30 mmHg in ≥ 8 of the 10 wet swallows are classified as type I, those with pan-esophageal pressurization to > 30 mmHg in at least 2 out of the 10 wet swallows are classified as type II and those with preserved fragments of distal peristalsis or premature (spastic) contractions in 2 or more of the 10 swallows are classified as type III. 30 The value of IRP had to be > 10 mmHg to diagnose type I and > 15 mmHg to diagnose type II and III achalasia.…”

Section: Diagnosis and Sub-typing Of Achalasiamentioning

confidence: 99%

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Achalasia Is Associated With eNOS4a4a, iNOS22GA, and nNOS29TT Genotypes: A Case-control Study

Singh

Ghoshal

Misra

et al. 2015

J Neurogastroenterol Motil

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Background/AimsAchalasia is known to result from degeneration of inhibitory neurons, which are mostly nitrinergic. Characteristic features of achalasia include incomplete lower esophageal sphincter (LES) relaxation and esophageal aperistalsis. Nitric oxide (NO), produced by NO synthase (NOS), plays an important role in peristalsis and LES relaxation. Therefore, we evaluated genetic polymorphisms of NOS gene isoforms (endothelial NOS [eNOS], inducible NOS [iNOS], and neuronal NOS [nNOS]) in patients with achalasia and healthy subjects (HS). MethodsConsecutive patients with achalasia (diagnosed using esophageal manometry) and HS were genotyped for 27-base pair (bp) eNOS variable number of tandem repeats (VNTR), iNOS22G/A (rs1060826), nNOS C/T (rs2682826) polymorphisms by polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism (RFLP), respectively. Results Among ConclusionsAchalasia is associated with eNOS4a4a, iNOS22GA, and nNOS29TT genotypes. This may suggest that polymorphisms of eNOS, iNOS, and nNOS genes are risk factors for achalasia.

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Section: Diagnosis and Sub-typing Of Achalasiamentioning

confidence: 99%

Section: Diagnosis and Sub-typing Of Achalasiamentioning

confidence: 99%

Section: Diagnosis and Sub-typing Of Achalasiamentioning

confidence: 99%

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Achalasia Is Associated With eNOS4a4a, iNOS22GA, and nNOS29TT Genotypes: A Case-control Study

Singh

Ghoshal

Misra

et al. 2015

J Neurogastroenterol Motil

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“…Based on average esophageal body amplitude, achalasia is classified into classic (≤ 40 mmHg) and vigorous types (> 40 mmHg) 3. Vigorous achalasia is considered as the early stage in the natural history of the disease 4,5. Treatment of achalasia is usually palliative in nature 6.…”

Section: Introductionmentioning

confidence: 99%

A Review of Factors Predicting Outcome of Pneumatic Dilation in Patients With Achalasia Cardia

Ghoshal¹,

Murali²

2011

J Neurogastroenterol Motil

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Pneumatic dilation (PD) is an effective treatment for achalasia cardia. Outcome of PD, however, varies among different studies. Recently, some groups started considering laparoscopic myotomy to be competitive to PD in treatment of achalasia considering dreaded complication like perforation following the latter therapeutic approach. Therefore, there is need to predict outcome of PD for achalasia, so that appropriate therapy, both for treatment naïve and for treatment failed patients can be chosen. Apart from age and gender, 2 investigations, namely post-PD manometry and timed barium esophagogram are most often used to predict outcome after PD. Even though there are studies available in the literature with regard to these modalities to predict outcome of PD, these are quite few in number, including small number of patients, primarily because of rarity of the disease. In this article, we review the literature predicting outcome of PD for achalasia.

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“…Conventional manometry may miss esophageal motility disorders causing dysphagia. In a study on 250 patients with motor dysphagia, the cause could not be identified by conventional manometry in 15 % patients [8]. This might be due to widely spaced sensors in the catheter.…”

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confidence: 97%

Chicago classification of high-resolution esophageal manometry: Is old the gold or is new better?

Ghoshal

2014

Indian J Gastroenterol

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High-resolution manometry (HRM), a landmark concept in gastrointestinal motility study, was introduced in the early 1990s by Clouse and Staiano [1]. In this new technology, pressure profile is assessed during several liquid and viscous swallows using a catheter having a large number of ports at closely spaced positions in the esophagus [2]. Time, catheter position, and average pressure are then reconstructed into pseudo-3D "topographic plots" that demonstrated the functional anatomy of the esophagus and that of the gastroesophageal junction taking gastric pressure as the baseline [2].There are several advantages of HRM over conventional manometry [2][3][4][5][6][7]. The advantages may be broadly classified into two groups, (a) those related to the recording of the data and (b) those related to the display of the data. The advantages of HRM over conventional manometry with respect to the data recording include (a) higher number of sensors that record lumen-occlusive contractions of the circular muscle of esophagus (typically six to eight ports in the earlier conventional manometry in contrast to 32 ports in current HRM), (b) use of solid-state catheter with higher fidelity in place of water-perfusion catheters, (c) use of circumferential in place of non-circumferential sensors, (d) facility to evaluate bolus transport by impedance monitoring that is available in most of the standard HRM devises, and (e) HRM is easier to perform than the conventional manometry. Display of the complex data using Clouse plot is a major advantage of HRM over conventional manometry. In the conventional manometry, the horizontal (X) axis depicts the time and the vertical (Y) axis represents the amplitude of contraction. In the Clouse plot of HRM, the horizontal (X) axis depicts the time, but the vertical (Y) axis represents the length of the esophagus. How to depict the amplitude of contraction then? Ray E Clouse decided to use different colors to represent the amplitude of contraction, the deep blue being the most negative pressure, and black showing highest positive pressure. Conventional manometry may miss esophageal motility disorders causing dysphagia. In a study on 250 patients with motor dysphagia, the cause could not be identified by conventional manometry in 15 % patients [8]. This might be due to widely spaced sensors in the catheter. Due to large number of sensors, HRM is expected to have higher fidelity to diagnose esophageal motility disorders, which has been documented in the literature [9]. One of the many advantages of the Clouse plot in HRM is the ease with which different esophageal motility disorders can be grossly recognized by the experienced motility doctors, but in the era of super-speciality health care using evidenced-based medicine and various mathematical scoring systems, are the doctors and patients happy with gross recognition of disorders?Chicago classification system has been developed by consensus among a group of motility experts based on the available evidence and general principles of esophageal physi...

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Manometric and symptomatic spectrum of motor dysphagia in a tertiary referral center in northern India

Abstract: Classic AC was the commonest cause of motor dysphagia in our center. AC was associated with higher LES pressure, longer duration of dysphagia, frequent regurgitation and bolus obstruction.

Cited by 17 publications

References 22 publications

Achalasia Is Associated With eNOS4a4a, iNOS22GA, and nNOS29TT Genotypes: A Case-control Study

Achalasia Is Associated With eNOS4a4a, iNOS22GA, and nNOS29TT Genotypes: A Case-control Study

A Review of Factors Predicting Outcome of Pneumatic Dilation in Patients With Achalasia Cardia

Chicago classification of high-resolution esophageal manometry: Is old the gold or is new better?

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