Spectrum and Clinical Outcome of Motility Disorders on High-Resolution Esophageal Manometry: A Study From a Tertiary Center on Patients With Dysphagia in Pakistan

Rehman, Hareem; Abid, Adeel; Awan, Safia; Hashmi, Farheen Lubna; Abid, Shahab

doi:10.7759/cureus.12088

Cited by 5 publications

(3 citation statements)

References 21 publications

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“…[24] In our study, barium esophagogram was suggestive for the diagnosis of achalasia in 80.64% of patients. This was in accordance with Rehman et al [17] who recorded in their cross-sectional study that barium esophagogram was sensitive for the diagnosis of achalasia proved by HRM in 63.9% of the patients. Also, Schima et al [25] found that the diagnosis of achalasia by barium esophagogram was made in 58% of the patients with manometrically proven achalasia.…”

Section: Discussionsupporting

confidence: 92%

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Different patterns of esophageal motility disorders among patients with dysphagia and normal endoscopy: A 2-center experience

et al. 2022

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Esophageal motility disorders (EMDs) are the main etiology of nonobstructive dysphagia (NOD), but they are underestimated in Egypt. High-resolution manometry (HRM) with Chicago Classification version 3.0 (CC v3.0) is the current gold standard diagnostic modality to assess EMD in patients with NOD. In this HRM-based study, we aimed to classify EMD among Egyptian patients and explore the relationship between the severity of symptoms and the various groups of EMD. From January 2020 to January 2021, patients with dysphagia were subjected to diagnostic workup, which included symptom questionnaire for Eckardt score, esophagogastroduodenoscopy, barium esophagogram, and HRM. All patients were categorized based on the HRM results using CC version 3.0 after exclusion of those with obstructive esophageal lesions. Of 252 patients with dysphagia, 55 patients with NOD were analyzed according to CC version 3.0. Achalasia was diagnosed in 31 patients (56.4%) (type I: 18 [58.06%]; type II: 9 [29.03%], and type III: 4 [12.9%]), 3 patients (5.5%) with esophagogastric junction outflow obstruction, 2 patients (3.6%) with absent contractility, 4 patients (7.3%) with distal esophageal spasm, 7 patients (12.7%) with ineffective esophageal motility, and 8 patients (14.5%) with normal manometry. Patients with achalasia experienced significantly high regurgitation (96.8% vs 70.8%; P = .016) compared with those without achalasia. Achalasia was the most common EMD in Egyptian patients with NOD. Eckardt score was higher in patients with outflow obstruction and major motor disorder, but it could not differentiate different categories of CC of EMD. HRM is effective in characterization of EMD.

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Section: Discussionsupporting

confidence: 92%

“…Twenty percent patients had normal manometry. Also, Rehman et al [ 17 ] who have demonstrated that achalasia was the most common diagnosis in their studied cases (35.6%) followed by DES (13.0%). Then weak peristalsis with large peristaltic defects was less common (7.9%).…”

Section: Discussionmentioning

confidence: 77%

Different patterns of esophageal motility disorders among patients with dysphagia and normal endoscopy: A 2-center experience

et al. 2022

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“…Serotonin and norepinephrine reuptake inhibitors are antidepressants and act by binding to the serotonin and norepinephrine transporters (73). Serotonin and norepinephrine reuptake inhibitors also act in the lower esophageal function (Level 2b; Grade: B) (74,75). However, no study addresses their use in achalasia patients, and consequently, their use should be restricted to research protocols (Level 5; Grade: D).…”

Section: Serotonin and Norepinephrine Reuptake Inhibitorsmentioning

confidence: 99%

Evaluating the Non-conventional Achalasia Treatment Modalities

Tustumi

2022

Front. Med.

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IntroductionAchalasia is a primary esophageal dysmotility disorder. Despite the high volume of studies addressing the conventional treatments for achalasia, few are debated regarding the non-conventional treatments, such as cardiectomy, cardioplasty, endoluminal substances injection (ethanolamine oleate, polidocanol, botulinum toxin), stents, and certain drugs (beta-agonists, anticholinergic, nitrates, calcium channel blockers, and phosphodiesterase inhibitors).MethodsA critical review was performed.ResultsEndoscopic, surgical, and pharmacological treatments were included. A qualitative synthesis was presented.ConclusionNon-conventional therapeutic options for treating achalasia encompass medical, endoscopic, and surgical procedures. Clinicians and patients need to know all the tools for the management of achalasia. However, several currently available studies of non-conventional treatments lack high-quality evidence, and future randomized trials are still needed.

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Esophageal motility disorders in symptomatic patients and its relation to age

et al. 2023

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Background Although swallowing disorders can impact individuals of any age, some are unique to the elderly, and others are frequent. Some disorders, such as achalasia, are diagnosed by esophageal manometry studies, which assess lower esophageal sphincter (LES) pressure and relaxation, peristalsis in the esophageal body, and contraction wave characteristics. This research aimed to evaluate esophageal motility dysfunction in symptomatic patients and its relation to age. Methods Conventional esophageal manometry was performed on 385 symptomatic patients who were divided into two groups; Group A (age < 65 years old) and Group B (age ≥ 65 years). The geriatric assessment for Group B included cognitive, functional, and clinical frailty scales (CFS). Additionally, a nutritional assessment was done for all patients. Results About one-third of the patients (33%) had achalasia, in which manometric results were significantly higher in Group B (43.4%) than in Group A (28.7%) (P = 0.016). The resting lower esophageal sphincter (LES) pressure, as determined by manometry examination, was significantly lower in Group A than in Group B. In contrast, complete LES relaxation percentage and normal esophageal body peristalsis were significantly higher in Group A than in Group B. Patients who exhibited evidence of achalasia in the manometric study had a significantly increased risk of established malnutrition and functional impairment. Conclusions Achalasia is a prevalent cause of dysphagia in elderly patients, placing them at risk of malnutrition and functional impairment. Thus, a multidisciplinary approach is vital when providing care for this population.

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Spectrum and Clinical Outcome of Motility Disorders on High-Resolution Esophageal Manometry: A Study From a Tertiary Center on Patients With Dysphagia in Pakistan

Cited by 5 publications

References 21 publications

Different patterns of esophageal motility disorders among patients with dysphagia and normal endoscopy: A 2-center experience

Different patterns of esophageal motility disorders among patients with dysphagia and normal endoscopy: A 2-center experience

Evaluating the Non-conventional Achalasia Treatment Modalities

Esophageal motility disorders in symptomatic patients and its relation to age

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