Lower Esophageal Sphincter Pressure Measurement Under Standardized Inspiratory Maneuveurs

Ribeiro, Jeany Borges e Silva; Diógenes, Esther Cristina Arruda Oliveira; Bezerra, Patrícia Carvalho; Coutinho, Tanila A.; Almeida, Cícera Geórgia Félix de; Souza, Miguel Angelo N.

doi:10.1590/s0102-67202015000300007

Cited by 7 publications

(5 citation statements)

References 6 publications

(8 reference statements)

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“…A control group was constituted in this research, due to the fact that manometric changes in the esophagus can occur in non-obese asymptomatic individuals 13 , 14 , 24 , 25 .…”

Section: Discussionmentioning

confidence: 99%

Preoperative Manometry for the Selection of Obese People Candidate to Sleeve Gastrectomy

Valezi

Herbella

Mali-Junior

et al. 2017

ABCD, arq. bras. cir. dig.

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Background:Sleeve gastrectomy may alter esophageal motility and lower esophageal sphincter pressure. Aim:To detect manometric changings in the esophagus and lower esophageal sphincter before and after sleeve gastrectomy in order to select patients who could develop postoperative esophageal motilitity disorders and lower esophageal sphincter pressure modifications. Methods:Seventy-three patients were selected. All were submitted to manometry before the operation and one year after. The variables analyzed were: resting pressure of the lower esophageal sphincter, contraction wave amplitude, duration of contraction waves, and esophageal peristalsis. Data were compared before and after surgery and to the healthy and non-obese control group. Exclusion criteria were: previous gastric surgery, reflux symptoms or endoscopic findings of reflux or hiatal hernia, diabetes and use of medications that could affect esophageal or lower esophageal sphincter motility. Results:49% of the patients presented preoperative manometric alterations: lower esophageal sphincter hypertonia in 47%, lower esophageal sphincter hypotonia in 22% and increase in contraction wave amplitude in 31%. One year after surgery, manometry was altered in 85% of patients: lower esophageal sphincter hypertonia in 11%, lower esophageal sphincter hypotonia in 52%, increase in contraction wave amplitude in 27% and 10% with alteration in esophageal peristalsis. Comparing the results between the preoperative and postoperative periods, was found statistical significance for the variables of the lower esophageal sphincter, amplitude of contraction waves and peristalsis. Conclusion:Manometry in the preoperative period of sleeve gastrectomy is not an exam to select candidates to this technique.

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“…A control group was constituted in this research, due to the fact that manometric changes in the esophagus can occur in non-obese asymptomatic individuals 13 , 14 , 24 , 25 .…”

Section: Discussionmentioning

confidence: 99%

Preoperative Manometry for the Selection of Obese People Candidate to Sleeve Gastrectomy

Valezi

Herbella

Mali-Junior

et al. 2017

ABCD, arq. bras. cir. dig.

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“…In recent times this surgery was most commonly performed in patients with body mass index (BMI) under 35 1 , 37 . These patients are an excellent group to perform this procedure 33 ; however, there is no consensus about its effects when patients suffer from gastroesophageal reflux disease (GERD). There are conflicting studies on the relationship between sleeve gastrectomy (SG) and GERD in the literature.…”

Section: Introductionmentioning

confidence: 99%

Sleeve Gastrectomy and Fundoplication as a Single Procedure in Patients With Obesity and Gastroesophageal Reflux

Lasnibat

Braghetto

Gutiérrez

et al. 2017

ABCD, arq. bras. cir. dig.

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Background:Bariatric surgery in Chile has seen an exponential increase in recent years, especially in sleeve gastrectomy. Its use is currently discussed in patients suffering from gastroesophageal reflux disease. Different options have been considered for the management of these patients but up to now laparoscopic Roux-en-Y gastric bypass seems to be the best option. Sleeve gastrectomy plus concomitant fundoplication or hiatal hernia repair also has been suggested in patients having reflux or small hiatal hernia. Aim: To present a cohort of obese patients with gatroesophageal reflux undergoing this procedure, which seeks to provide the benefits of both laparoscopic gastric sleeve (LSG) and antireflux surgery focused on the evaluation of presence of reflux and BMI after surgery, and to compare the result observed in this cohort with a previous group of obese patients without reflux submitted to sleeve gastrectomy alone. Methods:Retrospective case series in 15 patients who underwent this surgery between the years 2003 and 2012. Clinical records were analyzed and values of 24 hr pH monitoring, esophageal manometry and clinical outcome were recorded. Results were compared to a previous series of patients who underwent LSG. No statistical analyses were made. Results:Group A consisted of 15 patients submitted to LSG plus fundoplication. 93% (n=14) were female. Mean age was 46.2 years. Mean preoperative body mass index (BMI) was 33.9. All patients had altered pH monitoring and manometry preoperatively. There was one minor complication corresponding to a seroma. There was no perioperative mortality. Group B consisted of 23 obese patients who underwent LSG. These patients developed de novo reflux, hypotensive LES and esophagitis after the surgery. Group A patients showed improvement in esophageal pH monitoring and manometry at three months. During long-term follow-up, six underwent revision surgery, four for weight regain, one regained weight associated with symptomatic reflux, and one underwent re-intervention for reflux. Conclusions:Good results are observed in the short-term follow up in both reflux resolution and weight loss. Nevertheless, results at long term are discouraging, with 53.3% of the patients requiring revision surgery during follow-up.

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“…At end‐expiration the Pdi is only 6–10 mmHg and the smooth muscle LES portion of the EGJ with a pressure of 10–30 mm can be an effective anti‐reflux barrier. On the contrary, with inspiration, as the diaphragm contracts, there is a large increase in the Pdi (50 mmHg or more) and it is during these times that the crural diaphragm contraction which increases EGJ pressure (100 mmHg or more) is relevant for the prevention of reflux 25,35,36 . We measured Pdi and EGJ pressure during forced and tidal inspiration and found that the peak increase in Pdi does not coincide with the increase in EGJ pressure in patients with ILD.…”

Section: Discussionmentioning

confidence: 91%

“…On the contrary, with inspiration, as the diaphragm contracts, there is a large increase in the Pdi (50 mmHg or more) and it is during these times that the crural diaphragm contraction which increases EGJ pressure (100 mmHg or more) is relevant for the prevention of reflux. 25,35,36 We measured Pdi and EGJ pressure during forced and tidal inspiration and found that the peak increase in Pdi does not coincide with the increase in EGJ pressure in patients with ILD. The peak Pdi is greater and EGJ pressure smaller in ILD patients as compared to normal subjects.…”

Section: Discussionmentioning

confidence: 99%

Selective dysfunction of the crural diaphragm in patients with chronic restrictive and obstructive lung disease

Joshua,

Pathak,

Zifan

et al. 2023

Neurogastroenterology Motil

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BackgroundGastroesophageal reflux (GER) is known to be associated with chronic lung diseases. The driving force of GER is the transdiaphragmatic pressure (Pdi) generated mainly by costal and crural diaphragm contraction. The latter also enhances the esophagogastric junction (EGJ) pressure to guard against GER.MethodsThe relationship between Pdi and EGJ pressure was determined using high resolution esophageal manometry in patients with interstitial lung disease (ILD, n = 26), obstructive lung disease (OLD, n‐ = 24), and healthy subjects (n = 20).Key ResultsThe patient groups did not differ with respect to age, gender, BMI, and pulmonary rehabilitation history. Patients with ILD had significantly higher Pdi but lower EGJ pressures as compared to controls and OLD patients (p < 0.001). In control subjects, the increase in EGJ pressure at all‐time points during inspiration was greater than Pdi. In contrast, the EGJ pressure during inspiration was less than Pdi in 14 patients with ILD and 7 patients with OLD. The drop in EGJ pressure was usually seen after the peak Pdi in ILD group (p < 0.0001) and before the peak Pdi in OLD group, (p = 0.08). Nine patients in the ILD group had sliding hiatus hernia, compared to none in control subjects (p = 0.003) and two patients in the OLD, (p = 0.04).Conclusions and InferencesA higher Pdi and low EGJ pressure, and dissociation between Pdi and EGJ pressure temporal relationship suggests selective dysfunction of the crural diaphragm in patients with chronic lung diseases and may explain the higher prevalence of GERD in ILD as seen in previous studies.

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Lower Esophageal Sphincter Pressure Measurement Under Standardized Inspiratory Maneuveurs

Cited by 7 publications

References 6 publications

Preoperative Manometry for the Selection of Obese People Candidate to Sleeve Gastrectomy

Preoperative Manometry for the Selection of Obese People Candidate to Sleeve Gastrectomy

Sleeve Gastrectomy and Fundoplication as a Single Procedure in Patients With Obesity and Gastroesophageal Reflux

Selective dysfunction of the crural diaphragm in patients with chronic restrictive and obstructive lung disease

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