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Distal esophageal spasm:Update on diagnosis and management in the era of high-resolution manometry 被引量:1
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作者 Harika Gorti Salih Samo +1 位作者 Nikrad Shahnavaz Emad Qayed 《World Journal of Clinical Cases》 SCIE 2020年第6期1026-1032,共7页
Distal esophageal spasm (DES) is a rare major motility disorder in the Chicago dassification of esophageal motility disorders (CC).DES is diagnosed by finding of≥20%premature contractions,with normal lower esophageal... Distal esophageal spasm (DES) is a rare major motility disorder in the Chicago dassification of esophageal motility disorders (CC).DES is diagnosed by finding of≥20%premature contractions,with normal lower esophageal sphincter (LES)relaxation on high-resolution manometry (HRM) in the latest version of CCv3.0.This feature differentiates it from achalasia type 3,which has an elevated LES relaxation pressure.Like other spastic esophageal disorders,DES has been linked to conditions such as gastroesophageal reflux disease,psychiatric conditions,and narcotic use.In addition to HRM,ancillary tests such as endoscopy and barium esophagram can provide supplemental information to differentiate DES from other conditions.Functional lumen imaging probe (FLIP),a new cutting-edge diagnostic tool,is able to recognize abnormal LES dysfunction that can be missed by HRM and can further guide LES targeted treatment when esophagogastric junction outflow obstruction is diagnosed on FLIP.Medical treatment in DES mostly targets symptomatic relief and often fails.Botulinum toxin injection during endoscopy may provide a temporary therapy that wears off over time.Myotomy through peroral endoscopic myotomy or via surgical Heller myotomy can provide long term relief in cases with persistent symptoms. 展开更多
关键词 DISTAL esophageal SPASM high-resolution manometry esophagus Functional lumenal imaging probe SPASTIC ACHALASIA esophageal motility
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High-Resolution Esophageal Manometry in Teenagers with Esophageal Atresia
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作者 Cecilia Zubiri Rosa Ramos +20 位作者 Cecilia Curvale Raúl Matanó Paula Borobia Anabella Zosi Verónica Garrido Julieta Hernández Lucía Gutierrez Luciana Guzmán María Cristina Arregui Marina Prozzi Sandro Miculan Viviana Bernedo Maximiliano Fernández Rivas Cristina Lorenzo Florencia Recalde Verónica Valdiviezo Darío Fajre Cintia Antonioli Mariana Allende Claudia Losada Teresita Gonzalez 《Open Journal of Epidemiology》 2020年第1期81-89,共9页
Introduction: Children with surgically repaired esophageal atresia (EA) show esophageal dysmotility. Due to the performance of high-resolution manometry (HRM), three motility alteration patterns have been described, w... Introduction: Children with surgically repaired esophageal atresia (EA) show esophageal dysmotility. Due to the performance of high-resolution manometry (HRM), three motility alteration patterns have been described, which allowed to know the segmental alterations. Objective: To describe the esophageal motility patterns found through HRM in teenagers with EA and to relate these with the associated esophageal pathology and its severity. Materials and Method: Ten teenagers were included with no history of esophageal blockage or dilations in the last six months, who were orally fed and asymptomatic. Through performance of HRM, we found surgical and endoscopic history, as well as of esophageal biopsies and pH monitoring. Results: We found the following patterns: aperistalsis, pressurization and distal contraction. 70% showed distal contraction, and 100% of esophageal endoscopies and biopsies were normal. 57% of the esophageal pH monitoring analyzed was pathologic. In the pressurization and aperistalsis groups, we observed severe esophagitis and requirement of Nissen antireflux procedure in 100% of the cases. Esophageal pH monitoring analyzed was 100% pathologic. Conclusion: We described the esophageal segmental alterations in teenagers with atresia by means of HRM. The distal contraction group showed better development, without severe esophagitis or requirement of antireflux procedure. Therefore, by performing an HRM in teenagers with EA, we could predict the future esophageal behavior, according to the peristaltic pattern, since there are significant differences among the groups in study. 展开更多
关键词 high-resolution manometry esophageal ATRESIA TEENAGERS
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Upper esophageal sphincter abnormalities on high-resolution esophageal manometry and treatment response of type Ⅱ achalasia
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作者 Can-Ze Huang Zai-Wei Huang +3 位作者 Hua-Min Liang Zhen-Jiang Wang Ting-Ting Guo Yu-Ping Chen 《World Journal of Clinical Cases》 SCIE 2020年第4期723-735,共13页
BACKGROUND Little is known about the clinical significance of upper esophageal sphincter(UES)motility disorders and their association with the treatment response of typeⅡachalasia.None of the three versions of the Ch... BACKGROUND Little is known about the clinical significance of upper esophageal sphincter(UES)motility disorders and their association with the treatment response of typeⅡachalasia.None of the three versions of the Chicago Classification of Esophageal Motility Disorders has defined UES abnormality metrics or their function.UES abnormalities exist in some patients and indicate a clinically significant problem in patients with achalasia.AIM To demonstrate the manometric differentiation on high-resolution esophageal manometry between subjects with abnormal UES and normal UES,and the association between UES type and the treatment response of typeⅡachalasia.METHODS In total,498 consecutive patients referred for high-resolution esophageal manometry were analyzed retrospectively.The patients were divided into two groups,those with normal and abnormal UES function.UES parameters were analyzed after determining lower esophageal sphincter(LES)function.Patients with typeⅡachalasia underwent pneumatic dilation for treatment.Using mixed model analyses,correlations between abnormal UES and treatment response were calculated among subjects with typeⅡachalasia.RESULTS Of the 498 consecutive patients,246(49.40%)were found to have UES abnormalities.Impaired relaxation alone was the most common UES abnormality(52.85%,n=130).The incidence rate of typeⅡachalasia was significantly higher in subjects with abnormal UES than those with normal UES(9.77%vs 2.58%,P=0.01).After pneumatic dilation,LES resting pressure,LES integrated relaxation pressure,and UES residual pressure were significantly decreased(41.91±9.20 vs 26.18±13.08,38.94±10.28 vs 16.71±5.65,and 11.18±7.93 vs 5.35±4.77,respectively,P<0.05).According to the Eckardt score,subjects with typeⅡachalasia and abnormal UES presented a significantly poorer treatment response than those with normal UES(83.33%vs 0.00%,P<0.05).CONCLUSION Impaired relaxation alone is the most common UES abnormality.The incidence of typeⅡachalasia is associated with abnormal UES.TypeⅡachalasia with abnormal UES has a poorer treatment response,which is a potentially prognostic indicator of treatment for this disease. 展开更多
关键词 Upper esophageal sphincter high-resolution esophageal manometry ACHALASIA Treatment response
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Esophageal motility abnormalities in gastroesophageal reflux disease 被引量:22
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作者 Irene Martinucci Nicola de Bortoli +5 位作者 Maria Giacchino Giorgia Bodini Elisa Marabotto Santino Marchi Vincenzo Savarino Edoardo Savarino 《World Journal of Gastrointestinal Pharmacology and Therapeutics》 CAS 2014年第2期86-96,共11页
Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has... Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has markedly improved our understanding of the mechanisms contributing to the development of gastroesophageal reflux disease, allowing a better management of patients with this disorder. In this context, the present article intends to provide an overview of the current literature about esophageal motility dysfunctions in patients with gastroesophageal reflux disease. Esophageal manometry, by recording intraluminal pressure, represents the gold standard to diagnose esophagealmotility abnormalities. In particular, using novel techniques, such as high resolution manometry with or without concurrent intraluminal impedance monitoring, transient lower esophageal sphincter (LES) relaxations, hypotensive LES, ineffective esophageal peristalsis and bolus transit abnormalities have been better defined and strongly implicated in gastroesophageal reflux disease development. Overall, recent findings suggest that esophageal motility abnormalities are increasingly prevalent with increasing severity of reflux disease, from nonerosive reflux disease to erosive reflux disease and Barrett's esophagus. Characterizing esophageal dysmotility among different subgroups of patients with reflux disease may represent a fundamental approach to properly diagnose these patients and, thus, to set up the best therapeutic management. Currently, surgery represents the only reliable way to restore the esophagogastric junction integrity and to reduce transient LES relaxations that are considered to be the predominant mechanism by which gastric contents can enter the esophagus. On that ground, more in depth future studies assessing the pathogenetic role of dysmotility in patients with reflux disease are warranted. 展开更多
关键词 GASTROesophageal REFLUX disease high-resolution manometry Ineffective esophageal motility esophagogastric junction Transient lower esophageal SPHINCTER RELAXATIONS
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Effects of anti-hypertensive drugs on esophageal body contraction 被引量:5
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作者 Koichi Yoshida Kenji Furuta +7 位作者 Kyoichi Adachi Shunji Ohara Terumi Morita Takashi Tanimura Shuji Nakata Masaharu Miki Kenji Koshino Yoshikazu Kinoshita 《World Journal of Gastroenterology》 SCIE CAS CSCD 2010年第8期987-991,共5页
AIM:To clarify the effects of anti-hypertensive drugs on esophageal contraction and determine their possi-ble relationship with gastro-esophageal reflux disease.METHODS:Thirteen healthy male volunteers were enrolled. ... AIM:To clarify the effects of anti-hypertensive drugs on esophageal contraction and determine their possi-ble relationship with gastro-esophageal reflux disease.METHODS:Thirteen healthy male volunteers were enrolled. Esophageal body peristaltic contractions and lower esophageal sphincter (LES) pressure were measured using high resolution manometry. All subjects were randomly examined on four separate occasions following administrations of nifedipine,losartan,and atenolol,as well as without any drug administration.RESULTS:Peristaltic contractions by the esophageal body were separated into three segments by two troughs. The peak peristaltic pressures in the mid and lower segments of the esophageal body under atenolol administration were signifi cantly higher than those without medication in a supine position. On the other hand,peristaltic pressures under nifedipine administration were lower than those observed without drug ad-ministration. Losartan did not change esophageal body peristalsis. Atenolol elevated LES pressure and slowed peristaltic wave transition,while the effects of nifedip-ine were the opposite. CONCLUSION:Among the anti-hypertensive drugs tested,atenolol enhanced esophageal motor activity,which was in contrast to nifedipine. 展开更多
关键词 Anti-hypertensive drug high-resolution manometry Lower esophageal sphincter esophageal body contraction Calcium-channel blocker β1 blocker
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Changes in the esophagogastric junction outflow obstruction manometric feature based on the Chicago Classification updates
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作者 Yue-Yuan Li Wen-Ting Lu +3 位作者 Jian-Xiang Liu Li-Hong Wu Meng Chen Hong-Mei Jiao 《World Journal of Gastroenterology》 SCIE CAS 2022年第30期4163-4173,共11页
BACKGROUND The critical diagnostic criteria for esophagogastric junction outflow obstruction(EGJOO)were published in the latest Chicago Classification version 4.0(CCv4.0).In addition to the previous criterion[elevated... BACKGROUND The critical diagnostic criteria for esophagogastric junction outflow obstruction(EGJOO)were published in the latest Chicago Classification version 4.0(CCv4.0).In addition to the previous criterion[elevated integrated relaxation pressure(IRP)in supine position],manometric diagnosis of EGJOO requires meeting the criteria of elevated median-IRP during upright wet swallows and elevated intrabolus pressure.However,with the diagnostic criteria modification,the change in manometric features of EGJOO remained unclear.AIM To evaluate the esophageal motility characteristics of patients with EGJOO and select valuable parameters for confirming the diagnosis of EGJOO.METHODS We performed a retrospective analysis of 370 patients who underwent highresolution manometry with 5 mL water swallows×10 in supine,×5 in upright position and the rapid drink challenge(RDC)with 200 mL water from November 2016 to November 2021 at Peking University First Hospital.Fifty-one patients with elevated integrated supine IRP and evidence of peristalsis were enrolled,with 24 patients meeting the updated manometric EGJOO diagnosis(CCv4.0)as the EGJOO group and 27 patients not meeting the updated EGJOO criteria as the isolated supine IRP elevated group(either normal median IRP in upright position or less than 20%of supine swallows with elevated IBP).Forty-six patients with normal manometric features were collected as the normal high-resolution manometry(HRM)group.Upper esophageal sphincter(UES),esophageal body,and lower esophageal sphincter(LES)parameters were compared between groups.RESULTS Compared with the normal HRM group,patients with EGJOO(CCv4.0)had significantly lower proximal esophageal contractile integral(PECI)and proximal esophageal length(PEL),with elevated IRP on RDC(P<0.05 for each comparison),while isolated supine IRP elevated patients had no such feature.Patients with EGJOO also had more significant abnormalities in the esophagogastric junction than isolated supine IRP elevated patients,including higher LES resting pressure(LESP),intrabolus pressure,median supine IRP,median upright IRP,and IRP on RDC(P<0.05 for each comparison).Patients with dysphagia had significantly lower PECI and PEL than patients without dysphagia among the fifty-one with elevated supine IRP.Further multivariate analysis revealed that PEL,LESP,and IRP on RDC are factors associated with EGJOO.The receiver-operating characteristic analysis showed UES nadir pressure,PEL,PECI,LESP,and IRP on RDC are parameters supportive for confirming the diagnosis of EGJOO.CONCLUSION Based on CCv4.0,patients with EGJOO have more severe esophagogastric junction dysfunction and are implicated in the proximal esophagus.Additionally,several parameters are supportive for confirming the diagnosis of EGJOO. 展开更多
关键词 esophagogastric junction outflow obstruction high-resolution manometry esophageal motility disorders Upper esophageal sphincter Proximal esophagus
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基于深度学习的高分辨率食管测压图谱鉴别
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作者 吕志贤 侯木舟 曹聪 《中北大学学报(自然科学版)》 CAS 2023年第6期669-678,共10页
高分辨率食管测压技术(High-Resolution Manometry,HRM)被广泛应用于食管运动诊断,而芝加哥分类的方法难度大、耗时长、效率低,且随着HRM图像数据量的爆炸式增长,误诊率也随之增加。为了提高临床诊断的准确率与效率,本文将搭建一个更加... 高分辨率食管测压技术(High-Resolution Manometry,HRM)被广泛应用于食管运动诊断,而芝加哥分类的方法难度大、耗时长、效率低,且随着HRM图像数据量的爆炸式增长,误诊率也随之增加。为了提高临床诊断的准确率与效率,本文将搭建一个更加高效的计算机辅助诊断系统帮助医生对HRM图像进行自动判别分析,提出了改进的深度学习模型(Improved-VGG)来完成对HRM图像食管收缩活力的正常收缩、全段增压、弱收缩、无效收缩分类的任务,该模型中增加了Batch Normalization层和Dropout层,显著提升了HRM图像分类的训练速度,并修改了卷积核大小,用更大的卷积核提取特征。实验使用了2520幅专家标记的HRM图像,用于训练、验证和测试的图像分别占比为70%,10%和20%。实验结果表明,在测试集上,食管收缩活力分类器的分类准确率和精度分别为97.20%和93.97%,特异度和召回率分别为98.05%和93.97%。本文的正常收缩、全段增压、弱收缩、无效收缩分类(NFWIC)模型能较好地适应HRM图像数据的特性,其临床实践应用将提高医生的诊断效率。 展开更多
关键词 高分辨率食管测压图谱 深度学习 卷积神经网络 改进的VGG网络模型 医学影像
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Gender,medication use and other factors associated with esophageal motility disorders in non-obstructive dysphagia
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作者 Afrin Kamal Sampurna Shakya +1 位作者 Rocio Lopez Prashanthi N.Thota 《Gastroenterology Report》 SCIE EI 2018年第3期177-183,I0002,共8页
Background:High-resolution esophageal manometry(HREM)is the diagnostic test of choice for evaluation of nonobstructive dysphagia.Studies regarding the predictors of esophageal dysmotility are limited.Therefore,our aim... Background:High-resolution esophageal manometry(HREM)is the diagnostic test of choice for evaluation of nonobstructive dysphagia.Studies regarding the predictors of esophageal dysmotility are limited.Therefore,our aim was to study the prevalence of and factors associated with esophageal motility disorders in patients with non-obstructive dysphagia.Methods:We performed a retrospective review of all patients with non-obstructive dysphagia who underwent HREM in a tertiary center between 1 January 2014 and 31 December 2015.After obtaining IRB approval(16–051),clinical records were scrutinized for demographic data,symptoms,medication use,upper endoscopic findings and esophageal pH findings.HREM plots were classified per Chicago Classification version 3.0.Primary outcome was prevalence of esophageal motility disorders;secondary outcomes assessed predictive factors.Results:In total,155 patients with non-obstructive dysphagia(55616 years old,72%female)were identified.HREM diagnosis was normal in 49%followed by ineffective esophageal motility in 20%,absent contractility in 7.1%,achalasia type II in 5.8%,outflow obstruction in 5.2%,jackhammer esophagus in 4.5%,distal esophageal spasm in 3.9%,fragment peristalsis in 1.9%,achalasia type I in 1.9%,and achalasia type III in 0.6%.Men were five times more likely to have achalasia than women[odds ratio(OR)5.3,95%confidence interval(CI):2.0–14.2;P=0.001].Patients with erosive esophagitis(OR 2.9,95%CI:1.1–7.7;P=0.027)or using calcium channel blockers(OR 3.0,95%CI:1.2–7.4;P=0.015)were three times more likely to have hypomotility disorders.Conclusion:From this study,we concluded that HREM diagnosis per Chicago Classification version 3.0 was normal in 49%of patients with non-obstructive dysphagia.Male gender,erosive esophagitis and use of calcium channel blockers were predictive of esophageal motility disorders. 展开更多
关键词 Impaired swallowing high-resolution esophageal manometry esophageal motility disorders
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食管动力检测方法的临床价值与进展
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作者 庄茜钧 肖英莲 《中国中西医结合消化杂志》 CAS 2023年第7期518-522,共5页
近年来食管动力检测技术和方法均出现了革新,本文将对高分辨率食管测压(high-resolution esophageal manometry,HRM)、内镜下功能性腔内成像探针(functional lumen imaging probe,FLIP)全景技术与钡食管造影等常见食管动力检测技术的临... 近年来食管动力检测技术和方法均出现了革新,本文将对高分辨率食管测压(high-resolution esophageal manometry,HRM)、内镜下功能性腔内成像探针(functional lumen imaging probe,FLIP)全景技术与钡食管造影等常见食管动力检测技术的临床应用与进展进行综述。HRM是诊断食管动力障碍性疾病的金标准检查,包括胃食管连接部流出道障碍疾病和食管蠕动障碍疾病的诊断。近年新发布的芝加哥分类4.0对HRM诊断标准进行了部分修改,并强调了激发试验的辅助诊断价值。内镜下FLIP全景技术是一项评估食管动力的新技术,其根据胃食管连接部的可扩张情况与食管体部收缩模式对食管动力进行分类。FLIP全景技术可实时观察食管动力情况以及评估食管继发性蠕动,相比HRM具有独特的优越性。钡食管造影是梗阻性食管动力障碍的一种重要的补充诊断工具,如果患者不能耐受侵入性检查,钡食管造影也是一种理想的替代检查。 展开更多
关键词 食管测压 功能性腔内成像探针技术 食管动力
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