Prospective manometric evaluation with pharmacologic provocation of patients with suspected esophageal motility dysfunction

Benjamin, Stanley B.; Richter, Joel E.; Cordova, Carmel M.; Knuff, Thomas E.; Castell, Donald O.

doi:10.1016/0016-5085(83)90187-7

Cited by 162 publications

(34 citation statements)

References 12 publications

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“…Transient relaxations of the LOS (TRLOS), an incompetent LOS and abnormalities of the muscular function of the oesophagus, which are termed motility disorders and can result in the loss of peristaltic activity in the oesophageal body, are some of the reasons for lack of clearance of gastric contents in the oesophagus [22]. The most common symptoms associated with gastroesophageal reflux include heartburn, regurgitation, dysphagia and chest pain [23,24].…”

Section: Anatomy and Physiology Of The Oesophagusmentioning

confidence: 99%

Intrinsic Causes of Erosion

Moazzez

Bartlett²

2014

Monographs in Oral Science

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Gastric juice entering the mouth causes dental erosion. Common causes for the migration of gastric juice through the lower and upper oesophageal sphincters are reflux disease, laryngopharyngeal reflux, eating disorders, chronic alcoholism and pregnancy. Gastroesophageal reflux is a common condition affecting up to 65% of the Western population at some point in their lifetime. A typical clinical sign of acidic gastric juice entering the mouth is palatal dental erosion. As the condition becomes more chronic it becomes more widespread. There have been relatively few randomised studies investigating the aetiology of acids causing erosion. Of the few that have reported their findings, it appears that gastric acids have the potential to induce moderate-to-severe erosion. This literature review reports the conditions associated with the movement of gastric juice and dental erosion using medical and dental sources.

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Section: Anatomy and Physiology Of The Oesophagusmentioning

confidence: 99%

Intrinsic Causes of Erosion

Moazzez

Bartlett²

2014

Monographs in Oral Science

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“…However, an oesophageal aetiology is frequently inferred from either conventional manometric findings, typically obtained while the patient is asymptomatic, or experimental provocation of like symptoms after oesophageal distension, acid instillation, or the use of pharmacological agents.2' 24 It has often been argued that experimental provocation techniques are non-physiological and, therefore, possibly not representative of the oesophageal event accompanying spontaneous symptoms. These criticisms have been addressed, to some extent, by the use of long term ambulatory intraoesophageal pH monitoring in the assessment of chest pain, and, more recently, combined oesophageal motility and pH monitoring.25--9 There seems to be some disparity, however, in the proportion of patients in whom either acid reflux or dysmotility could be attributed to the occurrence of spontaneous chest pain.…”

Section: Discussionmentioning

confidence: 99%

Oesophageal motility, luminal pH, and electrocardiographic-ST segment analysis during spontaneous episodes of angina like chest pain.

Hick

Morrison

Casey

et al. 1992

Gut

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“…The diagnosis of achalasia had been established by short term manometry using absence of peristalsis in the oesophageal body and absent or incomplete LOS relaxations in response to 10 swallows of 5 ml of water as the most important criteria 9. Symptoms associated with achalasia were present for an average period of six years (range 0–36) before enrolment.…”

Section: Methodsmentioning

confidence: 99%

“…Short term stationary manometric recording is the gold standard for the diagnosis of achalasia showing absence of peristalsis and incomplete or absent LOS relaxation in response to wet swallows 9. The simultaneous pressure waves that are seen in the oesophageal body of achalasia patients during conventional manometry usually have a low amplitude 10.…”

mentioning

confidence: 99%

Prolonged manometric recordings of oesophagus and lower oesophageal sphincter in achalasia patients

Herwaarden

Samsom

Smout

2001

Gut

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Background and aims-Conventional short term manometry is a valuable tool in the diagnosis of achalasia but the technique may fail to detect intermittent motor events. The aim of this study was to investigate the pattern of lower oesophageal sphincter (LOS) and oesophageal pressures during prolonged recording in patients with achalasia. Methods-Eleven patients with idiopathic achalasia were studied. Prolonged combined oesophageal pH and manometric recordings of the pharynx, LOS, and stomach were performed using a pH glass electrode and a multiple lumen assembly incorporating a Dent sleeve connected to a portable water perfused manometric system. Results-LOS pressure varied during the day. Postprandial LOS pressures were lower than those recorded preprandially (1.2 v 1.8 kPa; p=0.005) and basal LOS pressures were significantly higher during phase III of the migrating motor complex than during the subsequent phase I (3.3 v 1.8 kPa; p=0.028). Complete LOS relaxations were occasionally observed in seven patients (0.48/h). Complete LOS relaxations were longer in duration than incomplete LOS relaxations (10.8 v 2.8 s; p=0.01) and 57% of complete relaxations fulfilled the criteria of a transient LOS relaxation (TLOSR). Complete LOS relaxations were associated with oesophageal pressure waves with higher amplitudes and longer durations. In addition, a higher proportion of these oesophageal pressure waves were spontaneous (55.6% v 0%; p<0.02) and multipeaked (72.7% v 0%). During prolonged manometry, high amplitude oesophageal pressure waves (>10 kPa) were recorded in six patients and retrograde oesophageal pressure waves in four, phenomena which were not observed during short term manometry. Conclusion-In contrast with short term stationary manometry, prolonged manometry in achalasia patients revealed the occurrence of complete LOS relaxations, TLOSRs, variations in LOS pressure associated with a meal or phase III, and high amplitude and retrograde oesophageal pressure waves. (Gut 2001;49:813-821) Keywords: achalasia; lower oesophageal sphincter; manometry; oesophagus Achalasia is a rare primary neurogenic motility disorder of the oesophagus and lower oesophageal sphincter (LOS) with dysfunction of the inhibitory innervation as the most prominent feature.1 Neuropathological findings in the oesophagus and LOS of achalasia patients include degeneration and reduction of ganglion cells within the myenteric plexus, reduction of vasoactive intestinal polypeptide and nitric oxide nerve fibres in the myenteric plexus, and degenerative lesions of the vagal nerves and the dorsal motor nucleus of the vagal nerve.2-7 These neuronal abnormalities are associated with non-specific changes in oesophageal smooth muscle. 8Short term stationary manometric recording is the gold standard for the diagnosis of achalasia showing absence of peristalsis and incomplete or absent LOS relaxation in response to wet swallows. The simultaneous pressure waves that are seen in the oesophageal body of achalasia patients during conventional manome...

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Prospective manometric evaluation with pharmacologic provocation of patients with suspected esophageal motility dysfunction

Cited by 162 publications

References 12 publications

Intrinsic Causes of Erosion

Intrinsic Causes of Erosion

Oesophageal motility, luminal pH, and electrocardiographic-ST segment analysis during spontaneous episodes of angina like chest pain.

Prolonged manometric recordings of oesophagus and lower oesophageal sphincter in achalasia patients

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