INTRODUCTION: Long-term outcome data are limited for non-achalasia esophageal motility disorders treated by peroral endoscopy myotomy (POEM) as a separate group. We investigated a subset of symptomatic patients with hypercontractile esophagus (Jackhammer esophagus). METHODS: Forty two patients (mean age 60.9 years; 57% female, mean Eckardt score 6.2 ± 2.1) treated by primary peroral myotomy for symptomatic Jackhammer esophagus 2012-2018 in seven European centers were retrospectively analyzed; myotomy included the lower esophageal sphincter but did not extend more than 1 cm into the cardia in contrast to POEM for achalasia. Manometry data were re-reviewed by an independent expert. The main outcome was the failure rate defined by retreatment or an Eckardt score >3 after at least two years following POEM. RESULTS: Despite 100% technical success (mean intervention time 107 ± 48.9 min, mean myotomy length 16.2 ± 3.7 cm), the 2-year success rate was 64.3% in the entire group. In a subgroup analysis, POEM failure rates were significantly different between Jackhammer-patients without (n = 22), and with esophagogastric junction outflow obstruction (EGJOO, n = 20) (13.6% % vs. 60%, p = 0.003) at a follow-up of 46.5 ± 19.0 months. Adverse events occurred in nine cases (21.4%). 14 (33.3%) patients were retreated, two with surgical fundoplication due to reflux. Including retreatments, an improvement in symptom severity was found in 33 (78.6%) at the end of follow-up (Eckardt score ≤3, mean Eckardt change 4.34, p < 0.001). EGJOO (p = 0.01) and frequency of hypercontractile swallows (p = 0.02) were predictors of POEM failure. The development of a pseudodiverticulum was observed in four cases within the subgroup of EGJOO. CONCLUSIONS: Patients with symptomatic Jackhammer without EGJOO benefit from POEM in long-term follow-up. Treatment of Jackhammer with EGJOO, however, remains challenging and probably requires full sphincter myotomy and future studies which should address the pathogenesis of this variant and alternative strategies.
- MeSH
- Esophageal Achalasia surgery diagnosis physiopathology MeSH
- Esophageal Sphincter, Lower surgery physiopathology MeSH
- Adult MeSH
- Natural Orifice Endoscopic Surgery methods adverse effects MeSH
- Esophagoscopy methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Manometry * methods MeSH
- Myotomy * methods MeSH
- Follow-Up Studies MeSH
- Esophageal Motility Disorders * surgery diagnosis etiology MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
With technical progress of gastrointestinal functional testing, there has been a demand for more comprehensive examination of esophageal physiology and pathophysiology beyond high-resolution manometry. A new interventional technology based on impedance planimetry, the functional lumen imaging probe (FLIP), enables intraluminal measurement of distensibility and compliance of hollow organs. EndoFLIP uses balloon catheters to measure diameter and distension pressure to calculate cross-sectional area and distensibility in different organs (mostly esophagus, stomach, anorectal region) and can be used in wide variety of indications (diagnostics, pre- and post-treatment evaluation) and currently serves as a helpful adjunctive tool in ambiguous clinical cases. EsoFLIP is a therapeutic variation that uses a stiffer balloon catheter allowing for dilation. The trend to simplify the clinical process from diagnosis to treatment tends to a one-session procedure combining diagnostics and therapeutic interventions. In specified conditions like e.g. achalasia or gastroparesis, a combination of EndoFLIP and EsoFLIP procedures may therefore be useful. The aim of this narrative review is to introduce the clinical use of FLIP and its potential benefit in combined diagnostic-therapeutic procedures.
The pathogenesis of gastroesophageal reflux disease (GERD) is multifactorial. The severity of abnormal reflux burden corresponds to the dysfunction of the antireflux barrier and inability to clear refluxate. The crural diaphragm is one of the main components of the esophagogastric junction and plays an important role in preventing gastroesophageal reflux. The diaphragm, as a skeletal muscle, is partially under voluntary control and its dysfunction can be improved via breathing exercises. Thus, diaphragmatic breathing training (DBT) has the potential to alleviate symptoms in selected patients with GERD. High-resolution esophageal manometry (HRM) is a useful method for the assessment of antireflux barrier function and can therefore elucidate the mechanisms responsible for gastroesophageal reflux. We hypothesize that HRM can help define patient phenotypes that may benefit most from DBT, and that HRM can even help in the management of respiratory physiotherapy in patients with GERD. This systematic review aimed to evaluate the current data supporting physiotherapeutic practices in the treatment of GERD and to illustrate how HRM may guide treatment strategies focused on respiratory physiotherapy.
- MeSH
- Breathing Exercises MeSH
- Esophagogastric Junction MeSH
- Gastroesophageal Reflux * MeSH
- Humans MeSH
- Manometry methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
- Systematic Review MeSH
Úvod: Anorektální manometrie s vysokým rozlišením (high resolution, HRAM) je diagnostická metoda indikovaná u pacientů s anorektální dysfunkcí. Cílem studie bylo vyhodnotit prevalenci anorektální dysfunkce a posoudit terapeutické konsekvence. Metody: Byla vyhodnocena retrospektivní data konsekutivních pacientů referovaných k HRAM v období od března 2019 do února 2021. Posouzeny byly základní manometrické parametry: klidový anální tlak (resting pressure; RP), maximální tlak v sevření (squeeze pressure; SP), citlivost rekta (rectal sensitivity; RS) a dyssynergní defekace (DD). Výsledky: Analyzováno bylo 113 pacientů s kombinací fekální inkontinence a obstrukčním defekačním syndromem (FI + ODS: 44,2 %), fekální inkontinencí (FI: 26,5 %), obstrukčním defekačním syndromem (ODS: 16,8 %), se stomiemi před obnovením střevní kontinuity (6,2 %), funkční pánevní bolestí (FP: 3,5 %) a sporné případy (2,7 %). Průměrný věk byl 54 let, převažovaly ženy (72 %). Pacienti s FI a FI + ODS měli nižší průměrný RP (57 mmHg a 53 mmHg) a/nebo nižší SP (160 mmHg a 140 mmHg) v porovnání s referenčními hodnotami. Pacienti s ODS měli průměrný RP (75 mmHg) a SP (225 mmHg) v normě. DD byla zaznamenána u většiny pacientů (FI: 76,6 %, FI+ODS: 88 %, ODS: 89,5 %, FP: 100 %). Nejčastěji byla poskytnuta konzervativní terapie s fyzioterapií pánevního dna (FI+ODS: 40 %, ODS: 36,8 %, FI: 13,3 %, FP: 75 %). Závěr: U pacientů s poruchami defekace je vysoká prevalence patologických manometrických nálezů, které se vzájemně kombinují. Na základě vyhodnocených parametrů lze zahájit konzervativní léčbu společně s cílenou a individuální fyzioterapií pánevního dna.
Introduction: High resolution anorectal manometry (HRAM) is a diagnostic method indicated in patients with anorectal dysfunction. The aim of the study was to evaluate the prevalence of anorectal dysfunctions and to assess therapeutic consequences. Methods: Retrospective data of consecutive patients referred to HRAM in the period from March 2019 to February 2021 were evaluated. Basic manometric parameters were assessed: resting pressure (RP), maximal squeeze pressure (SP), rectal sensitivity (RS), and dyssynergic defecation (DD). Results: 113 patients with combined fecal incontinence and obstructive defecation syndrome (FI + ODS: 44.2%), fecal incontinence (FI: 26.5%), obstructive defecation syndrome (ODS: 16.8 %), stoma before restoration of intestinal continuity (6.2%), functional pelvic pain (FP: 3.5 %) and controversial cases (2.7%) were analyzed. The average age was 54 years; female patients predominated (72 %). Patients with FI and FI+ODS had lower mean RP (57 mmHg and 53 mmHg) and/or lower SP (160 mmHg and 140 mmHg) compared to baseline. Patients with ODS had normal values of mean RP (75 mmHg) and SP (225 mmHg). DD was noted in most patients (FI: 76.6%, FI + ODS: 88%, ODS: 89.5%, FP: 100%). Conservative therapy with pelvic floor physiotherapy was provided in most cases (FI+ODS: 40%, ODS: 36.8%, FI: 13.3%, FP: 75%). Conclusion: In patients with defecation disorders there is a high prevalence of pathological manometric findings that combine with each other. Based on manometric findings, conservative treatment with individual pelvic floor physiotherapy can be initiated.
- MeSH
- Medical History Taking MeSH
- Defecation physiology MeSH
- Diagnosis, Differential MeSH
- Child MeSH
- Fecal Incontinence classification MeSH
- Humans MeSH
- Manometry methods MeSH
- Polyethylene Glycols administration & dosage MeSH
- Laxatives administration & dosage classification MeSH
- Age Factors MeSH
- Constipation * diagnosis diet therapy etiology drug therapy pathology therapy MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Review MeSH
Postihnutie hornej časti tráviaceho traktu u pacientov s Parkinsonovou chorobou sa v literatúre zmieňuje menej často než postihnutie jeho dolnej časti. Jeho klinický význam je ale značný, pretože dysfágické ťažkosti významne znižujú kvalitu života pacientov a môžu viesť k život ohrozujúcim komplikáciám. Napriek tomu, že klinické ťažkosti sa spájajú skôr s pokročilejšími štádiami ochorenia, poruchy motility pažeráka ako dôsledok Parkinsonovej choroby možno pomocou pažerákovej manometrie s vysokým rozlíšením zachytiť oveľa skôr. Autori v článku popisujú základné princípy diagnostického manažmentu dysfágie u pacientov s Parkinsonovou chorobou a v klinickej časti prezentujú analýzu vlastného súboru pacientov. Zistili, že nešpecifické a rôznorodé poruchy motility sú prítomné u väčšiny pacientov aj v neprítomnosti dysfágických symptómov. V experimentálnej časti sme načrtli nové možnosti diagnostických postupov pomocou najmodernejších metodík detekcie patologických foriem alfa-synukleínu a pokročilých mikroskopických metód.
Involvement of the upper part of the gastrointestinal tract in patients with Parkinson disease is reported less frequently than the involvement of the lower part. Its clinical impact is, however, substantial because dysphagic symptoms considerably decrease the quality of life and may lead to life threatening complications. Even though the clinical symptoms related to esophageal motility disorders as a result of Parkinson disease are more common in the advanced stages of the disease, these could be diagnosed much earlier using high resolution manometry. The authors describe the basic principles of diagnostic management of dysphagia in patients with Parkinson disease and in the clinical part they present an analysis of their patient cohort. They found out that nonspecific and diverse motility disorders are present in most patients, even without dysphagic symptoms. In the experimental part, we outlined new possibilities for diagnostic procedures using the most up-to-date methods for the detection of pathological forms of alpha-synuclein and advanced microscopic methods.
- Keywords
- FLIM analýza,
- MeSH
- alpha-Synuclein MeSH
- Immunohistochemistry MeSH
- Clinical Studies as Topic MeSH
- Humans MeSH
- Manometry methods MeSH
- Parkinson Disease * complications MeSH
- Esophageal Motility Disorders * diagnosis etiology MeSH
- Deglutition Disorders diagnosis etiology MeSH
- Check Tag
- Humans MeSH
Zácpa představuje častou příčinu návštěv v ordinaci dětského lékaře, ale i gastroenterologa. Dlouhodobé potíže s vyprázdněním vedou k bolestem, obavám, psychické alteraci, při jejich neléčení dochází ke zhoršování stavu s rozvojem pseudoinkontinence a retence stolice. Terapie je velmi zdlouhavá a komplexní. Anorektální manometrie představuje diagnostickou metodu vyhodnocující funkční parametry anorektální aktivity. Ve sledovaném období (2016-2021) podstoupilo na Chirurgické klinice FN Ostrava manometrické vyšetření celkem 94 dětských pacientů s příznaky obstipace. Představujeme výsledky naší provedené studie.
Constipation is a very common reason for children to visit the general paediatrician or gastroenterologist. Long-term problems regarding stools emptying lead to pain, anxiety and mental alteration. If not treated, the constipation symptoms worsen with the development of pseudoincontinence and stool retention. The therapy is complex and prolonged. Anorectal manometry is a diagnostic method evaluating the functional parameters of anorectal activity. In the monitored period (2016-2021), a total of 94 paediatric patients with symptoms of constipation underwent a anorectal manometry at the Surgical Department of the University Hospital Ostrava. We present the results of our manometry study.
- MeSH
- Child MeSH
- Fecal Incontinence MeSH
- Clinical Studies as Topic MeSH
- Humans MeSH
- Manometry * methods MeSH
- Constipation * diagnosis MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Review MeSH
OBJECTIVES: Dysfunctions in the lower esophageal sphincter (LES) and the upper esophageal sphincter (UES) levels can occur owing to poor muscle coordination, contraction, or relaxation. Such condition can possibly be addressed by functional rehabilitation. The aim of this study was to measure pressure changes in the UES and LES at rest and during routine rehabilitation techniques, that is, cervical manual traction and trunk stabilization maneuver. METHODS: This study was conducted in a University Hospital Gastrointestinal Endoscopy Center. Cervical manual traction and a trunk stabilization maneuver were performed in a convenient group of 54 adult patients with gastroesophageal reflux disease. High-resolution manometry was used to measure pressure changes in the LES and UES at rest and during manual cervical traction and trunk stabilization maneuver. RESULTS: Average initial resting UES pressure was 90.91 mmHg. A significant decrease was identified during both cervical traction (average UES pressure = 42.13 mmHg, P < .001) and trunk stabilization maneuver (average UES pressure = 62.74 mmHg, P = .002). The average initial resting LES pressure was 14.31 mmHg. A significant increase in LES pressure was identified both during cervical traction (average LES pressure = 21.39 mmHg, P < .001) and during the trunk stabilization maneuver, (average pressure = 24.09 mmHg, P < .001). CONCLUSION: Cervical traction and trunk stabilization maneuvers can be used to decrease pressure in the UES and increase LES pressure in patients with gastroesophageal reflux disease.
- MeSH
- Esophageal Sphincter, Lower physiology MeSH
- Adult MeSH
- Gastroesophageal Reflux physiopathology rehabilitation MeSH
- Esophageal Sphincter, Upper physiology MeSH
- Muscle, Skeletal innervation MeSH
- Middle Aged MeSH
- Humans MeSH
- Manipulation, Spinal methods MeSH
- Manometry methods MeSH
- Muscle Relaxation physiology MeSH
- Pressure MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
- Geographicals
- Czech Republic MeSH
