Esophageal manometry in patients with dysphagia, gastroesophageal reflux (GER) and non-cardiac chest pain
Diagnostic utility
Keywords:
MANOMETRY, GASTROESOPHAGEAL REFLUX, DEGLUTITION DISORDER, CHEST PAIN
Abstract
Introduction: esophageal manometry is the chosen procedure or gold standard technique for the diagnosis of esophageal motor disorders.
Objectives: to assess the usefulness of esophageal manometry (EMS), to examine manometry diagnosis according to symptoms and to compare results with published data.
Method: we analyzed the medical records and manometric tracings of 104 patients at the Gastroenterology Clinic of the Clinicas University Hospital, between March 2005 and October 2007, according to the symptoms that motivated the study: dysphagia (54), gastroesophageal reflux disease (GER) (43), and non-cardiac chest-pain (7).
Patients with endoscopic and heart alterations were not included in the study.
Results: we found manometric alterations in 75.9% of patients with dysphagia, being achalasia the most frequent disorder. In the gastroesophageal reflux disease group (GER), 69.8 % of manometries were abnormal, being ineffective peristalsis the most frequent alteration. In the chest pain group, manometric alterations added up to 71.4 %. Diagnostic usefulness of esophageal manometry was 73.1% (76/104; IC95%: 63,5-81,3).
Conclusions: esophageal manomery in this series had a high diagnostic usefulness (73,1%), which may be compared to other published studies. Manometric diagnosis for each group agree with those reportes by other authors in Europe and United States, there being no studies published in Latin America to assess the three groups included in this study. Despite there being no meaningful differences, EMS had a higher diagnostic usefulness in the dysphagia group.
References
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(30) Csendes A, Cárcamo C, Henríquez A. Características clínicas, endoscópicas, manométricas y magnitud de reflujo gastroesofágico ácido patológico en pacientes con esófago en cascanueces. Análisis prospectivo de 80 pacientes. Rev Méd Chile 2004; 132: 160-4.
(31) Rao SS, Hayek B, Summers RW. Functional chest pain of esophageal origin: hiperalgesia or motor dysfunction. Am J Gastroenterol 2001; 96(9): 2584-9.
(32) Pilhall M, Börjesson M, Rolny P, Mannheimer C. Diagnosis of nutcracker esophagus, segmental or diffuse hypertensive patterns, and clinical characteristics. Dig Dis Sci 2002; 47(6): 1381-8.
(33) Börjesson M, Pilhall M, Rolny P, Mannheimer C. Gastroesophageal acid reflux in patients with nutcracker esophagus. Scand J Gastroenterol 2001; 9: 916-20.
(34) Fang J, Bjorkam D. Nutcraker esophagus: GERD or an esophageal motility disorder. Am J Gastroent 2002; 97: 1556-7.
(35) Galmiche JP, Clouse RE, Balint A, Cook IJ, Kahrilas PJ, Paterson WG, et al. Functional esophageal disorders. Gastroenterology 2006; 130: 1459-65.
(36) Rose S, Young MA, Reynolds JC. Gastrointestinal manifestations of scleroderma. Gastroenterol Clin North Am 1998; 27(3): 563-94.
(37) Smout AJ. Manometry of the gastrointestinal tract: toy or tool? Scand J Gastroenterol Suppl. 2001; (234): 22-8.
(38) Castell DO. The spectrum of esophageal motility disorders. Gastroenterology 1979; 76: 639.
(39) Alrakawi A, Clouse RE. The changing use of esophageal manometry in clinical practice. Am J Gastroenterol 1998; 93(12): 2359-62.
(2) Kahrilas PJ, Clouse RE, Hogan WJ. American Gastroenterological Association technical review on the clinical use of esophageal manometry. Gastroenterology 1994; 107: 1865-84.
(3) Spechler SJ, Castell DO. Classification of oesophageal motility abnormalities. Gut 2001; 49: 145-51.
(4) Castell DO. Historical perspectives and current use of esophageal manometry. En: Castell DO. Esophageal motility testing. 2 ed. Connecticut: Appleton & Lange, 1994: 3-12.
(5) Suárez Crespo JF, Jordán Madrid T, Esteban Carretero J. Trastornos motores esofágicos primarios. Rev Gastroenterol 2002; 1: 1-28.
(6) Mittal RK, Bhalla V. Oesophageal motor functions and its disorders. Gut 2004; 53: 1536-42.
(7) Ciriza de los Ríos C, García Menéndez L, Díez Hernández A, Delgado Gómez M, Fernández Eroles AL, Vega Fernández A, et al. Papel de la manometría esofágica estacionaria en la práctica clínica. Resultados manométricos en pacientes con reflujo gastroesofágico, disfagia y dolor torácico no cardiaco. Rev Esp Enferm Dig 2004; 96(9): 606-11.
(8) Rencoret G, Csendes A, Henríquez A. Estudio mamométrico del esófago en pacientes con dolor torácico no cardíaco. Rev Méd Chile 2006; 134: 291-8.
(9) Henríquez A, Csendes A, Rencoret G, Braghetto I. Prevalencia de los diferentes trastornos motores primarios del esófago. Estudio prospectivo de 5.440 casos. Rev Méd Chile 2007; 135: 1270-5.
(10) Dekel R, Pearson T, Wendel C, De Garmo P, Fennerty B, Fass R. Assessment of oesophageal motor function in patients with dysphagia or chest pain – the clinical outcomes research initiative experience. Aliment Pharmacol Ther 2003; 18(11): 1083-9.
(11) Pandolfino JE, Kahrilas PJ. AGA technical review on the clinical use of esophageal manometry. Gastroenterology 2005; 128: 209-24.
(12) Ragunath K, Williams JG. A review of oesophageal manometry testing in a district general hospital. Postgrad Med J 2002; 78: 34-6.
(13) Katz PO, Dalton CB, Richter JE, Wu WC, Castell DO. Esophageal testing of patients with noncardic chest pain or dysphagia. Ann Intern Med 1987; 106(4): 593-7.
(14) Praderi LA, Balboa O, Ricciardi N. Megaesófago. Acalasia. Cir Urug 1982; 52(4): 323.
(15) Estapé Carriquiry G. Acalasia. In: Estapé Carriquiry G, Taruselli R. Estenosis esofágicas del adulto. Montevideo: Academia Nacional de Medicina, 2001:61-7.
(16) Salvatella R. Enfermedad de Chagas: informe de situación en el Uruguay. Rev Méd Urug 1993; 9: 65-6.
(17) Rosa R, Basmadjián Y, González Murguiondo M, González Arias M, Salvatella R. Actualización clínico-epidemiológica y terapéutica de la enfermedad de Chagas en Uruguay. Rev Méd Urug 2001; 17(2): 125-32.
(18) Csendes A, Uribe P, Larraín A. Motility studies on fifty patients with achalasia of the esophagus. Am J Gastroent 1974; 62: 333-6.
(19) Vaezi MF, Richter JE. Diagnosis and management of achalasia. American College of Gastroenterology Practice Parameter Committee. Am J Gastroenterol 1999; 94(12): 3406-12.
(20) Tutuian R, Castell DO. Review article: oesophageal spasm– diagnosis and management. Aliment Pharmacol Ther 2006; 23: 1393-402.
(21) Dalton CB, Castell DO, Hewson EG, Wu WC, Richter JE. Diffuse esophageal spasm. A rare motility disorder not characterized by high-amplitud contractions. Dig Dis Sci 1991; 36(8): 1025-8.
(22) Campos GMR, Peters JH, DeMeester TR, Öberg S, Crookes PF, Mason RJ. The pattern of esophageal acid exposure in gastroeophageal reflux disease influences the severity of the disease. Arch Surg 1999; 134: 882-7.
(23) Carmona Sánchez R, Valerio Ureña J, Valdovinos Díaz MA. El esfínter esofágico inferior hipertenso. Prevalencia y características clinicomanométricas. Rev Gastroenterol Mex 2001; 66(4): 174-8.
(24) Csendes A, Burdiles P, Maluenda F, Cortés C. Características clínicas y de laboratorio en pacientes con reflujo gastroesofágico crónico patológico. Rev Méd Chile 1998; 126: 769-80.
(25) Santander Vaquero C. Peristalsis esofágica ineficaz. Rev Castellana Ap Dig 2005; 21(2): 37-8.
(26) Leite LP, Johnston BT, Barrett J, Castell JA, Castell DO. Ineffective esophageal motility (IEM). The primary finding in patients with non-specific esophageal motility disorder. Dig Dis Sci 1997; 42(9): 1859-65.
(27) Rhee PL, Hyun JG, Lee JH, Kim YH, Son HJ, Kim JJ, et al. The effect of sildenafil on lower esophageal sphincter and body motility in normal male adults. Am J Gastroenterol 2001; 96: 3251-7.
(28) Simren M, Silny J, Holloway R, Tack J, Janssens J, Sifrim D. Relevance of ineffective oesophageal motility during oesophageal acid clearance. Gut 2003; 53: 784-90.
(29) Ward BW, Wu WC, Richter JE, Hackshaw BT, Castell DO. Long term follow-up of symptomatic status of patients with non-cardiac chest pain: is diagnosis of esophageal etiology helpful? Am J Gastroenterol 1987; 82: 215-8.
(30) Csendes A, Cárcamo C, Henríquez A. Características clínicas, endoscópicas, manométricas y magnitud de reflujo gastroesofágico ácido patológico en pacientes con esófago en cascanueces. Análisis prospectivo de 80 pacientes. Rev Méd Chile 2004; 132: 160-4.
(31) Rao SS, Hayek B, Summers RW. Functional chest pain of esophageal origin: hiperalgesia or motor dysfunction. Am J Gastroenterol 2001; 96(9): 2584-9.
(32) Pilhall M, Börjesson M, Rolny P, Mannheimer C. Diagnosis of nutcracker esophagus, segmental or diffuse hypertensive patterns, and clinical characteristics. Dig Dis Sci 2002; 47(6): 1381-8.
(33) Börjesson M, Pilhall M, Rolny P, Mannheimer C. Gastroesophageal acid reflux in patients with nutcracker esophagus. Scand J Gastroenterol 2001; 9: 916-20.
(34) Fang J, Bjorkam D. Nutcraker esophagus: GERD or an esophageal motility disorder. Am J Gastroent 2002; 97: 1556-7.
(35) Galmiche JP, Clouse RE, Balint A, Cook IJ, Kahrilas PJ, Paterson WG, et al. Functional esophageal disorders. Gastroenterology 2006; 130: 1459-65.
(36) Rose S, Young MA, Reynolds JC. Gastrointestinal manifestations of scleroderma. Gastroenterol Clin North Am 1998; 27(3): 563-94.
(37) Smout AJ. Manometry of the gastrointestinal tract: toy or tool? Scand J Gastroenterol Suppl. 2001; (234): 22-8.
(38) Castell DO. The spectrum of esophageal motility disorders. Gastroenterology 1979; 76: 639.
(39) Alrakawi A, Clouse RE. The changing use of esophageal manometry in clinical practice. Am J Gastroenterol 1998; 93(12): 2359-62.
Published
2009-03-31
How to Cite
1.
Pose AC, Reyes L, Saona G, Umpierre V. Esophageal manometry in patients with dysphagia, gastroesophageal reflux (GER) and non-cardiac chest pain. Rev. Méd. Urug. [Internet]. 2009Mar.31 [cited 2024Nov.17];25(1):34-. Available from: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/477
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