scholarly journals A Patient with Uncontrollable Belching: What to Do?

2019 ◽  
Vol 28 (6) ◽  
pp. 68-76 ◽  
Author(s):  
I. V. Maev ◽  
Yu. A. Kucheryaviy ◽  
E. V. Barkalova ◽  
M. A. Ovsepyan
Keyword(s):  
Differential Diagnosis ◽  
High Resolution ◽  
Esophageal Manometry ◽  
Speech Therapy ◽  
Clinical Observation ◽  
Behavioural Disorders ◽  
Speech Therapist ◽  
Esophageal Sphincter ◽  
The Moment ◽  
Transient Relaxation

Aim.In this paper, we discuss the clinical significance of belching and present a clinical case with the description of the belching differential diagnosis.Main findings.Belching may be either a physiological or a pathological phenomenon. Pathological belching requires an adequate diagnostic approach in order to clarify the nature of its occurrence. Gastric belching occurs reflexively at the moment of stomach stretching by excess air trapped during swallowing, which initiates the transient relaxation of the lower esophageal sphincter. As a consequence, the swallowed air escapes from the stomach first into the esophagus and then into the throat. Supragastric belching is a phenomenon, in which the air entering the esophagus does not reach the stomach, but rapidly returns to the throat. In this case, unlike aerophagia, the air entering the esophagus is not accompanied by the act of swallowing. Supragastric belching is not a reflex process; rather, it is considered to be a manifestation of behavioural disorders. 24-hour pH-impedancemetry and high-resolution esophageal manometry are highly informative methods for detecting various types of belching (gastric and supragastric), as well as their mechanisms. We present a clinical observation of a 47-year-old patient suffering from supragastric belching and treated by speech therapy under the supervision of a speech therapist.Conclusion.24-hour pH-impedancemetry and high-resolution esophageal manometry (also in combination with impedancemetry) provide a complete differential diagnosis of belching and allow the most effective patient management strategy to be selected.

scholarly journals The importance of functional diagnostics in determining the cause of antisecretary therapy inefficiency in a patient with heartburn: clinical observation

2021 ◽  
pp. 46-53
Author(s):  
E. V. Barkalova ◽  
D. N. Andreev ◽  
M. A. Ovsepian
Keyword(s):  
Differential Diagnosis ◽  
High Resolution ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Research Methods ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Reflux Disease ◽  
Esophageal Manometry ◽  
Clinical Observation

One of the main symptoms of gastroesophageal reflux disease is heartburn, for the relief of which proton pump inhibitors are traditionally prescribed. However, there are frequent cases of heartburn, refractory to antisecretory therapy, when there is no complete relief of the symptom or only a partial clinical effect. The reason for an unsatisfactory response may be the functional genesis of heartburn. The purpose of the presented clinical observation is to demonstrate the heterogeneity of patients with heartburn, the role of functional research methods in the differential diagnosis of various conditions that accompany this symptom. A 42-year-old patient was admitted for an additional clinical examination with complaints of heartburn refractory to antisecretory therapy, which included high-resolution esophageal manometry, 24-hours pH-impedance. The manometric assessment of the structure and function of the lower esophageal sphincter, as well as the contractility of the thoracic esophagus, revealed no violations. The data of 24-hours pH-impedance demonstrated the absence of pathological reflux and the association of active symptoms with refluxes, which determined the functional nature of heartburn and explained the ineffectiveness of treatment with proton pump inhibitors. Heartburn can be functional in  nature and significantly reduce the  quality of  life of  patients. Functional heartburn requires different management tactics from gastroesophageal reflux disease, which is based on an adequate differential diagnosis, including functional research methods such as high-resolution esophageal manometry and 24-hours pH-impedance measurement, which allow to exclude other conditions accompanied by similar symptoms. 

scholarly journals Impact of Laparoscopic Sleeve Gastrectomy on Esophageal Physiology

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Andrada-Loredana Popescu ◽  
Florentina Ioniţa-Radu ◽  
Mariana Jinga ◽  
Vasile-Daniel Balaban ◽  
Raluca-Simona Costache ◽  
...  
Keyword(s):  
Weight Loss ◽  
Sleeve Gastrectomy ◽  
High Resolution ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Lower Esophageal Sphincter ◽  
Esophageal Manometry ◽  
Morbidly Obese ◽  
Esophageal Physiology ◽  
Esophageal Sphincter ◽  
The Impact

Abstract Introduction: Laparoscopic sleeve gastrectomy (LSG) is a popular weight loss surgery technique, but the impact on esophageal physiology and esophagogastric junction is still debatable. The aim of our study was to evaluate the manometric changes of the lower esophageal sphincter (LES) after LSG in order to indicate LES manometry pre- procedure. Methods: In a prospective study we evaluated clinically, with upper gastrointestinal endoscopy, and high-resolution esophageal manometry 45 morbidly obese patients before, and 6-12 months after LSG. Results: The BMI (body mass index) decreased from 46.28±5.79 kg/m2 to 32.28±4.65 kg/m2 postoperatively (p <0.01), with a reduction of ~14 kg/m2 of BMI, 39.9 (±11.9) kg body weight and 29.9 (± 6.2)% of the TWL (Total Weight Loss index), in a median interval of 7.9 months. Gastroesophageal reflux disease (GERD) prevalence increased from 17.8% to 31.1% postoperatively, with new GERD onset in 22.2%, but mild symptomatology (the median GERDHRQL score increased from 1.56 to 2.84 points). Postoperatory reflux was associated with lower esophageal sphincter (LES) hypotonia, shortening of LES length and IIGP (increased intragastric pressure). Hiatal hernia repair rate was 17.8%, and proton pump inhibitor consumption 20%. After weight loss, the 10 cases of esophagitis discovered preoperatively cured, but 3 patients were diagnosed with de novo esophagitis. The prevalence of manometric dysmotility after LSG was 28.9%, lower than before surgery (44.4%). Conclusion: Even if GERD remains the main limitation of LSG, the high-resolution esophageal manometry has proved useful and should be implemented in morbidly obese evaluation protocol, to better select the bariatric procedure.

scholarly journals High-resolution esophageal manometry in patients with achalasia

2021 ◽  
Vol 180 (1) ◽  
pp. 45-53
Author(s):  
A. A. Smirnov ◽  
M. M. Kiriltseva ◽  
M. E. Luybchenko ◽  
L. I. Davletbaeva ◽  
A. V. Kochetkov
Keyword(s):  
High Resolution ◽  
Lower Esophageal Sphincter ◽  
Esophageal Manometry ◽  
Esophageal Achalasia ◽  
X Rays ◽  
High Resolution Manometry ◽  
Prospective Group ◽  
Unified View ◽  
Esophageal Sphincter ◽  
Integrated Relaxation Pressure

Introduction. At present, high-resolution esophageal manometry is the «gold standard» for the diagnosis of esophageal achalasia, based on the determination of the integrated relaxation pressure of the lower esophageal sphincter, the value of which in the case of achalasia must exceed 15 mm Hg (MMS System). However, in some patients with clinically and radiologically confirmed achalasia, this value is normal. There is no unified view of the cause of this phenomenon. We assumed that low pressure figures may be affected by incorrect installation of the manometric catheter.Methods and materials. This research included 149 patients (61 by retrospective estimating the patients data and 88 new patients) with achalasia established during the period from January 2017 to March 2020. When it was impossible to localize the lower esophageal sphincter and take correct measurements during high-resolution manometry in new patients, the X-rays or upper endoscopy was performed to control the manometric catheter placement. If its’ placement was incorrect and the integrated relaxation pressure level was lower than 15 mmHg, repeated high-resolution manometry was performed with the over-the-guidewire manometric catheter placing.Results. In 36 patients of both groups (24.2 %), the manometric data did not correspond to esophageal achalasia; in the prospective group, 12 out of the 19 patients had incorrect manometric data due to inability to visualize lower esophageal sphincter. In the prospective group, the manometric catheter was reinstalled by a guidewire, which allowed visualizing the signs of the lower esophageal sphincter in all cases, and in 15 out of 19 patients (79 %), the integrated relaxation pressure of the lower esophageal sphincter was more than 15 mm Hg.Conclusions. In some cases, the over-the-guidewire installing makes it possible to pass catheter through the lower esophageal sphincter correctly, visualize the lower esophageal sphincter during the high-resolution manometry examination and obtain true pressure values.

scholarly journals ESOPHAGEAL MOTILITY IN MEN AND WOMEN EVALUATED BY HIGH-RESOLUTION MANOMETRY

2017 ◽  
Vol 54 (2) ◽  
pp. 145-147 ◽  
Author(s):  
Tarciana Vieira COSTA ◽  
Roberto Oliveira DANTAS
Keyword(s):  
High Resolution ◽  
Esophageal Motility ◽  
Esophageal Manometry ◽  
Sitting Position ◽  
Men And Women ◽  
Proximal Contraction ◽  
High Resolution Manometry ◽  
Contraction Duration ◽  
Significant Difference ◽  
Esophageal Sphincter

ABSTRACT BACKGROUND Esophageal motility has been described in the literature as having differences between men and women. Most of these investigations use the water perfusion method for esophageal manometry. In this investigation the esophageal motility of men and women was compared with high-resolution manometry of the esophagus. OBJECTIVE To compare the esophageal motility of men and women with the high-resolution manometry method for esophageal manometry, performed in the sitting position. The hypothesis was that men and women have differences in esophageal motility. METHODS High-resolution manometry was performed in normal volunteers, 10 men [mean age: 37.5 (8.1) years] and 12 women [mean age: 38.7 (7.5) years], in the sitting position and with 10 swallows of a 5 mL bolus of saline, with an interval of at least 30 seconds between consecutive swallows. We evaluated the integrated relaxation pressure of the lower esophageal sphincter, contraction front velocity, distal contraction integral, distal latency, proximal contraction extension, proximal contraction duration >30 mmHg, proximal contraction duration, proximal contraction integral and maximal upper esophageal sphincter pressure. RESULTS There was no significant difference between men and women in the variables measured. CONCLUSION There was no difference in esophageal motility of men and women evaluated by the high resolution manometry method, in the sitting position with swallows of a liquid bolus.

scholarly journals Upper esophageal sphincter resting pressure varies during esophageal manometry

2014 ◽  
Vol 27 (3) ◽  
pp. 182-183 ◽  
Author(s):  
Daniel Tavares REZENDE ◽  
Fernando A. M. HERBELLA ◽  
Luciana C. SILVA ◽  
Sebastião PANOCCHIA-NETO ◽  
Marco G. PATTI
Keyword(s):  
High Resolution ◽  
Esophageal Manometry ◽  
Striated Muscle ◽  
Upper Esophageal Sphincter ◽  
Standard Test ◽  
Sphincter Pressure ◽  
High Resolution Manometry ◽  
Basal Pressure ◽  
Resting Pressure ◽  
Esophageal Sphincter

BACKGROUND: The upper esophageal sphincter is composed of striated muscle. The stress of intubation and the need to inhibit dry swallows during an esophageal manometry test may lead to variations in basal pressure of this sphincter. Upper esophageal sphincter is usually only studied at the final part of the test. Was observed during the performance of high resolution manometry that sphincter pressure may vary significantly over the course of the test. AIM: To evaluate the variation of the resting pressure of the upper esophageal sphincter during high resolution manometry. METHODS: Was evaluated the variation of the basal pressure of the upper esophageal sphincter during high resolution manometry. Were reviewed the high resolution manometry tests of 36 healthy volunteers (mean age 31 years, 55% females). The basal pressure of the upper esophageal sphincter was measured at the beginning and at the end of a standard test. RESULTS: The mean time of the test was eight minutes. The basal pressure of the upper esophageal sphincter was 100 mmHg at the beginning of the test and 70 mmHg at the end (p<0.001). At the beginning, one patient had hypotonic upper esophageal sphincter and 14 hypertonic. At the end of the test, one patient had hypotonic upper esophageal sphincter (same patient as the beginning) and seven hypertonic upper esophageal sphincter. CONCLUSION: A significant variation of the basal pressure of the upper esophageal sphincter was observed in the course of high resolution manometry. Probably, the value obtained at the end of the test may be more clinically relevant.

scholarly journals High resolution esophageal manometry and life exposure factors in non-cardiac chest pain patients with refractory gastroesophageal reflux disease

2019 ◽  
Author(s):  
Yuan Li ◽  
Peicong Lyu ◽  
Zhifeng Zhang ◽  
Liya Wang ◽  
Xiaoyu Sun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chest Pain ◽  
High Resolution ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Esophageal Manometry ◽  
Therapeutic Strategies ◽  
Anxiety And Depression ◽  
Esophageal Sphincter

Abstract Background: Refractory gastroesophageal reflux disease (RGERD) is defined by the presence of troublesome GERD symptoms despite proton pump inhibitors (PPIs) treatments for 8-12 weeks. Non-cardiac chest pain (NCCP) is the most common atypical presentations. This study was aimed at clarifying the features of High Resolution Esophageal Manometry (HREM) and life exposure factors of NCCP in RGERD patients for guiding further therapeutic strategies. Methods: 83 RGERD patients were enrolled, in which 44 patients afflicted with NCCP as P group and 39 patients without NCCP as NP group. According to the endoscopy results, P group was further divided into reflux esophagitis group (RE group), non-erosive reflux disease group (NERD group) and Barrett’s esophagus group (BE group). HREM was performed to assess esophageal motility. Diverse questionnaires were conducted to evaluate severity of symptoms, quality of life, risk factors, degrees of anxiety and depression and so on. Results: a)Average resting pressures of the lower esophageal sphincter (LES), residual pressures of the LES and the esophageal distal contractile integral (DCI) score in P group were significantly lower than those in NP group (p<0.05). b)Average resting pressures of the upper esophageal sphincter (UES), residual pressures of the UES, lengths of the LES and the UES showed no difference between the two groups (p>0.05). c)Compared with NP group, the patients in P group had higher exposure to alcohol, coffee, sweets, overeating and stress (p<0.05). d)Anxiety and depression status of patients in P group were remarkably severer than those in NP group (p<0.05). e)The pain intensity in RE group and BE group was higher than NERD group (P<0.05), while there was no difference between RE group and BE group (P>0.05). Conclusions: Esophageal motility related anti-reflux barriers are much weaker in the RGERD patients with NCCP than those without NCCP, which mainly presents as the much lower average resting and residual pressures of the LES and DCI. Alcohol, coffee, sweets, overeating, stress, anxiety and depression are risk factors of RGERD-related NCCP. It’s suggested that the recovery of anti-reflux barriers and the avoidance of risk factors may be essential therapeutic strategies for improving the curative effect.

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