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
BACKGROUND: Anorectal dysfunction (ARD), especially bowel incontinence, frequently compromises the quality of life in multiple sclerosis (MS) patients. The effect of rehabilitation procedures has not been clearly established. OBJECTIVE: To determine the effect of an individualized rehabilitation approach on bowel incontinence and anorectal pressures. METHODS: MS patients with ARD underwent 6-months of individually targeted biofeedback rehabilitation. High resolution anorectal manometry (HRAM) and St. Mark's Fecal Incontinence Scores (SMIS) were completed prior to rehabilitation, after 10 weeks of supervised physiotherapy, and after 3 months of self-treatment. RESULTS: Ten patients (50%) completed the study. Repeated measures analysis of variance (ANOVA) demonstrated significant improvement in the SMIS questionnaire over time [14.00 baseline vs. 9.70 after supervised physiotherapy vs. 9.30 after self-treatment (p = 0.005)]. No significant improvements over time were noted in any HRAM readings: maximal pressure [49.85 mmHg baseline vs. 57.60 after supervised physiotherapy vs. 60.88 after self-treatment (p = 0.58)], pressure endurance [36.41 vs. 46.89 vs. 49.95 (p = 0.53)], resting pressure [55.83, vs 52.69 vs. 51.84 (p = 0.704)], or area under the curve [230.0 vs. 520.8 vs. 501.9 (p = 0.16)]. CONCLUSIONS: The proposed individualized rehabilitation program supports a positive overall effect on anorectal dysfunction in MS patients.
- MeSH
- Biofeedback, Psychology MeSH
- Fecal Incontinence * etiology MeSH
- Quality of Life MeSH
- Humans MeSH
- Manometry MeSH
- Pilot Projects MeSH
- Multiple Sclerosis * complications MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article 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
História invazívneho merania tlaku krvi (TK), ktorá je dokumentovaná publikáciami, sa začína experimentami na zvieratách v 18. storočí. Ako prvý publikoval metodiku a výsledky meraní tlaku krvi Stephen Hales v „Statical Essays containing Haemastatics“ v roku 1733, avšak merania obsahujúce aj venózny tlak, rýchlosť toku krvi v aorte, minútový vývrhový objem srdca a iné, dokonca v rôznych situáciách robil už v prvej a druhej dekáde 18. storočia. Metodiku merania TK zdokonalil Poisseuille (1828) zostrojením hemodynamometra – U trubice naplnenej ortuťou. Kontinuálnu registráciu tlaku krvi umožnil od roku 1847 kymograf – vynález Ludwiga a použitie plaváčika v hemodynamometri. Túto metódu použil Faivre v roku 1856 prvýkrát u troch mužov pri amputácii končatín. Pre meranie tlaku krvi v rôznych úsekoch cirkulácie, vrátane srdca bolo potrebné zaviesť katetrizácie. Katetrizácie experimentálnych zvierat využívali Claude Bernard, Chauveau a Marey. U ľudí na rozvoji metodík katetrizácií srdca majú najväčšiu zásluhu Dieffenbach, Bleichröder, Unger, Montanari a nositeľ Nobelovej ceny Forssmann. Pri ďalšom rozvoji katetrizácií srdca a ciev mali významný podiel Klein, Cournand, Richardson, Swan a Ganz. Presný rok začatia invazívneho merania tlaku krvi u novorodencov nie je známy. V roku 1938 publikoval Woodbury prácu s meraním TK v a. umbilicalis Hamiltonovým hypodermickým manometrom. K rozvoju katetrizácií umbilikálnych ciev prispeli Diamond (1947) a James (1959). Začiatkom šesťdesiatych rokov 20. storočia vďaka skonštruovaniu presných elektromanometrov a vhodných katétrov nastal prelom v invazívnom meraní TK u novorodencov. Zaslúžili sa o to hlavne Wallgren, Rudolph, Moss, Gupta, Scopes aj ďalší. V súčasnosti je priame invazívne monitorovanie TK v neonatológii zlatý štandard. Táto metóda je potrebná pri získavaní beat-to-beat hodnôt TK a vtedy, keď nie je možné použiť neinvazívne metódy.
The history of invasive blood pressure measurement, documented in the literature, begins with animal experiments in the 18th century. Stephen Hales was the first who published the methodology and results of invasive blood pressure measurements in „Statical Essays containing Haemastatics“ in 1733, however, the measurements, including determination of the venous pressure, aortic blood flow rate, cardiac output, and others parameters in different situations were made in the first and second decades of the 18th century. Poisseuille improved the measurement of the blood pressure with the invention of the hemodynamometer, U-tube filled with mercury. Continuous registration of blood pressure has been made possible since 1847 by the kymograph - Ludwig's invention and the use of a float in the hemodynamometer. For the first time in humans was this method used by Faivre (1856) in three men during limb amputation. To measure blood pressure in various parts of the circulation, including the heart was necessary to introduce catheterizations. Catheterizations in experimental animals were used by Claude Bernard, Chauveau and Marey. The greatest contribution to the development of methods for cardiac catheterization in humans have Dieffenbach, Bleichröder, Unger, Montanari and Nobel Prize winner Forssmann. Very important role in the further development of cardiovascular catheterization played later Klein, Cournand, Richardson, Swan and Ganz. The exact year of beginning of the invasive blood pressure measurement in neonates is unknown. In 1938, Woodbury published a paper about measuring blood pressure in a. umbilicalis using Hamilton's hypodermic manometer. Diamond (1947) and James (1959) contributed to the development of catheterization of umbilical vessels. At the beginning of the sixties of the 20th century, thanks to the construction of accurate electromanometers and suitable catheters, there was a breakthrough in the invasive measurement of blood pressure in newborns. Wallgren, Rudolph, Moss, Gupta and Scopes were the pioneers of invasive blood pressure measurement in newborns. Recently, the direct invasive monitoring of blood pressure in neonatology is the gold standard. This method is necessary when obtaining beat-to-beat BP values and when non-invasive methods cannot be used.
- MeSH
- Humans MeSH
- Manometry history instrumentation MeSH
- Blood Pressure Determination * history methods instrumentation MeSH
- Models, Animal MeSH
- Infant, Newborn MeSH
- Cardiac Catheterization MeSH
- Animals MeSH
- Check Tag
- Humans MeSH
- Infant, Newborn MeSH
- Animals MeSH
- Publication type
- Historical Article MeSH
- Research Support, Non-U.S. Gov't 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
