Goals: To determine whether gastroenterologists use esophageal manometry (EM) and esophageal pH recording (pHR) in accordance with published guidelines. Study: Questionnaires were mailed to 900 randomly selected gastr...Goals: To determine whether gastroenterologists use esophageal manometry (EM) and esophageal pH recording (pHR) in accordance with published guidelines. Study: Questionnaires were mailed to 900 randomly selected gastroenterologists nationwide. Each questionnaire requested demographic information and contained 11 case scenario-based questions, followed by a choice of management options. Results: A total of 275 completed questionnaires (30.6% )were returned. 63.6% and 64.4% of respondents were aware of published guidelines regarding the use of EM and pHR, respectively. The majority of respondents ordered EM appropriately: 1) to confirm a suspected diagnosis of achalasia (97.1% ); 2) to establish a diagnosis of connective tissue disease (89.7% ); 3) as part of the preoperative evaluation for anti-reflux surgery (74.6% ); and 4) to ensure the proper placement of pH probes (69.4% ). EM was rarely ordered for the initial workup of noncardiac chest pain. The majority of responding gastroenterologists would order pHR for the evaluation of: 1) endoscopy-negative patients being considered for anti-reflux surgery (79.1% ); 2) patients with recurrent GERD symptoms after anti-reflux surgery (62.5% ); 3) endoscopy-negative patients with GERD symptoms refractory to proton pump inhibitor (PPI) therapy; and 4) patients with extraesophageal manifestations of GERD that are refractory to PPI therapy (88.7% ). Conclusions: The majority of gastroenterologists in our study order EM and pHR in accordance with published guidelines. However, EM appears to be used less than expected for preoperative evaluation before anti-reflux surgery and for ensuring the proper placement of pH probes. In addition, the use of pHR to evaluate persistent GERD symptoms after anti-reflux surgery was less than anticipated.展开更多
BACKGROUND: We hypothesized that functional anal incontinence with no structur al explanation comprises distinct pathophysiologic subgroups that could be ident ified on the basis of the predominant presenting bowel pa...BACKGROUND: We hypothesized that functional anal incontinence with no structur al explanation comprises distinct pathophysiologic subgroups that could be ident ified on the basis of the predominant presenting bowel pattern. METHODS: Consecu tive patients (n = 80) were prospectively grouped by bowel symptoms as 1) incont inence only, 2) incontinence +constipation, 3) incontinence +diarrhea, and 4) incontinence +alternating bowel symptoms. The Hopkins Bowel Symptom Questionnai re, the Symptom Checklist 90-R, and anorectal manometry were completed. RESULTS : Significant group differences were found between subcategories of incontinent patients on the basis of symptoms. Abdominal pain was more frequent in patients with altered bowel patterns. Patients with alternating symptoms reported the hig hest prevalence of abdominal pain, rectal pain, and bloating. Basal anal pressur es were significantly higher in alternating patients (P = 0.03). Contractile pre ssures in the distal anal canal were diminished in the incontinent only and dia rrhea groups (P = 0.004). Constipated patients with incontinence exhibited eleva ted thresholds for the urge to defecate (P = 0.027). Dyssynergia was significant ly more frequent in patients with incontinence and constipation or alternating b owel patterns. CONCLUSIONS: Distinct patterns of pelvic floor dysfunction were i dentified in patient subgroups with anal incontinence, based on the presence or absence of altered bowel patterns. Physiologic assessments suggested different p athophysiologic mechanisms among the subgroups. The evaluation of patients with fecal incontinence should consider altered bowel function.展开更多
文摘Goals: To determine whether gastroenterologists use esophageal manometry (EM) and esophageal pH recording (pHR) in accordance with published guidelines. Study: Questionnaires were mailed to 900 randomly selected gastroenterologists nationwide. Each questionnaire requested demographic information and contained 11 case scenario-based questions, followed by a choice of management options. Results: A total of 275 completed questionnaires (30.6% )were returned. 63.6% and 64.4% of respondents were aware of published guidelines regarding the use of EM and pHR, respectively. The majority of respondents ordered EM appropriately: 1) to confirm a suspected diagnosis of achalasia (97.1% ); 2) to establish a diagnosis of connective tissue disease (89.7% ); 3) as part of the preoperative evaluation for anti-reflux surgery (74.6% ); and 4) to ensure the proper placement of pH probes (69.4% ). EM was rarely ordered for the initial workup of noncardiac chest pain. The majority of responding gastroenterologists would order pHR for the evaluation of: 1) endoscopy-negative patients being considered for anti-reflux surgery (79.1% ); 2) patients with recurrent GERD symptoms after anti-reflux surgery (62.5% ); 3) endoscopy-negative patients with GERD symptoms refractory to proton pump inhibitor (PPI) therapy; and 4) patients with extraesophageal manifestations of GERD that are refractory to PPI therapy (88.7% ). Conclusions: The majority of gastroenterologists in our study order EM and pHR in accordance with published guidelines. However, EM appears to be used less than expected for preoperative evaluation before anti-reflux surgery and for ensuring the proper placement of pH probes. In addition, the use of pHR to evaluate persistent GERD symptoms after anti-reflux surgery was less than anticipated.
文摘BACKGROUND: We hypothesized that functional anal incontinence with no structur al explanation comprises distinct pathophysiologic subgroups that could be ident ified on the basis of the predominant presenting bowel pattern. METHODS: Consecu tive patients (n = 80) were prospectively grouped by bowel symptoms as 1) incont inence only, 2) incontinence +constipation, 3) incontinence +diarrhea, and 4) incontinence +alternating bowel symptoms. The Hopkins Bowel Symptom Questionnai re, the Symptom Checklist 90-R, and anorectal manometry were completed. RESULTS : Significant group differences were found between subcategories of incontinent patients on the basis of symptoms. Abdominal pain was more frequent in patients with altered bowel patterns. Patients with alternating symptoms reported the hig hest prevalence of abdominal pain, rectal pain, and bloating. Basal anal pressur es were significantly higher in alternating patients (P = 0.03). Contractile pre ssures in the distal anal canal were diminished in the incontinent only and dia rrhea groups (P = 0.004). Constipated patients with incontinence exhibited eleva ted thresholds for the urge to defecate (P = 0.027). Dyssynergia was significant ly more frequent in patients with incontinence and constipation or alternating b owel patterns. CONCLUSIONS: Distinct patterns of pelvic floor dysfunction were i dentified in patient subgroups with anal incontinence, based on the presence or absence of altered bowel patterns. Physiologic assessments suggested different p athophysiologic mechanisms among the subgroups. The evaluation of patients with fecal incontinence should consider altered bowel function.
