Can high resolution manometry parameters for achalasia be obtained by conventional manometry?

High resolution manometry(HRM) is a new technology that made important contributions to the field of gastrointestinal physiology. HRM showed clear advan-tages over conventional manometry and it allowed the creation of different manometric parameters. On the other side, conventional manometry is still wild available. It must be better studied if the new technology made possible the creation and study of these parameters or if they were always there but the colorful intuitive panoramic view of the peristalsis from the pharynx to the stomach HRM allowed the human eyes to distinguish subtle parameters unknown or uncomprehend so far and if HRM parameters can be reliably obtained by conventional manometry and data from conventional manometry still can be accepted in achalasia studies. Conventional manometry relied solely on the residual pressure to evaluate lower esophageal sphincter(LES) relaxation while HRM can obtain the Integrated Relaxation Pressure. Esophageal body HRM parameters defines achalasia subtypes, the Chicago classification, based on esophageal pressurization after swallows. The characterization of each subtype is very intuitive by HRM but also easy by conventional manometry since only wave amplitudes need to be measured. In conclusion, conventional manometry is still valuable to classify achalasia according to the Chicago classification. HRM permits a better study of the LES.

Gastroesophageal reflux disease and non-esophageal cancer

The association of gastroesophageal reflux disease(GERD) and esophageal cancer is well known.The carcinogenic properties of the gastroduodenal contents may also lead to cancer in target organs for GERD especially considering that they do not have intrinsic protective mechanisms as found in the esophagus.This review focuses on the putative relation between GERD and non-esophageal cancer.Most of the papers reviewed are far from ideal to prove the relationship of extraesophageal cancer and GERD since a small number ofpatients is presented,most do not control cases based on tobacco usage and obesity,and the diagnosis of GERD is variable,not always from an objective measurement such as p H monitoring but relying on symptoms in most reports.Nevertheless,head and neck and lung cancer have a growing incidence parallel to GERD and a shift towards non-smoking,female gender and adenocarcinoma(compared to squamous cell carcinoma) is arising,similar to the example of esophageal cancer with the exception of the female gender.

High resolution manometric findings in patients with Chagas' disease esophagopathy

Objective:To describe high resolution manometry features of a population of symptomatic- patients with Chagas’ disease esophagopathy(CDE).Methods:Sixteen symptomatic dysphagic patients with CDE[mean age(54.81±13.43) years,10 women]were included in this study.All patients underwent a high resolution manometry.Results:Mean lower esophageal sphincter(LES) extension was(3.02±1.17) cm with a mean basal pressure of(15.25±7.00) mmHg.Residual pressure was(14.31±9.19) mmHg.Aperistalsis was found in all 16 patients.Achalasia with minimal esophageal pressurization(type I) was present in 25%of patients and achalasia with esophageal compression(type 2) in 75%,according to the Chicago Classification.Upper esophageal sphincter(UES) mean basal pressure was(97.96±54.22) mmHg with a residual pressure of(12.95±6.42) mmHg.Conclusions:Our results show that LES was hypotensive or normotensive in the majority of the patients.Impaired relaxation was found in a minority of our patients.Aperistalsis was seen in 100%of patients.UES had impaired relaxation in a significant number of patients. Further clinical study is needed to investigate whether manometric features can predict outcomes following the studies of idiopathic achalasia..