Esophageal radiography and manometry: correlation in 172 patients with dysphagia

Dj, Ott; Richter, J. E.; Ym, Chen; Wc, Wu; Gelfand, DW; Do, Castell

doi:10.2214/ajr.149.2.307

Cited by 120 publications

(74 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…When dilation is very severe, the esophagus may have a sigmoid shape [3] . The overall sensitivity of barium swallow for diagnosis of achalasia is approximately 95% [24] , but in early stages of the disease it may be reported as normal. For example, in a prospective study achalasia was suggested by barium examination in only 21 out of 33 patients who eventually were diagnosed with achalasia [2] .…”

Section: Radiographymentioning

confidence: 99%

Achalasia: A review of Western and Iranian experiences

Mikaeli¹,

Islami²,

Malekzadeh³

2009

WJG

View full text Add to dashboard Cite

Achalasia is a primary motor disorder of the eso phagus, in which esophageal emptying is impaired. Diagnosis of achalasia is based on clinical findings. The diagnosis is confirmed by radiographic, endoscopic, and manometric evaluations. Several treatments for achalasia have been introduced. We searched the PubMed Database for original articles and meta analyses about achalasia to summarize the current knowledge regarding this disease, with particular focus on different procedures that are used for treatment of achalasia. We also report the Iranian experience of treatment of this disease, since it could be considered as a model for mediumresource countries. Myotomy, particularly laparoscopic myotomy with fundoplication, i s t h e m o s t e ffe c t i ve t re a t m e n t fo r a c h a l a s i a . Compared to other treatments, however, the initial cost of myotomy is usually higher and the recovery period is longer. When performing myotomy is not indicated or not possible, graded pneumatic dilation with slow rate of balloon inflation seems to be an effective and safe initial alternative. Injection of botulinum toxin into the lower esophageal sphincter before pneumatic dilation may increase remission rates. However, this needs to be confirmed in further studies. Due to lack of adequate information regarding the role of expandable stents in the treatment of achalasia, insertion of stents does not currently seem to be a recommended treatment. In summary, laparoscopic myotomy can be considered as the procedure of choice for treatment of achalasia. Graded pneumatic dilation is an effective alternative when the performance of myotomy is not possible for any reason.

show abstract

Section: Radiographymentioning

confidence: 99%

Achalasia: A review of Western and Iranian experiences

Mikaeli¹,

Islami²,

Malekzadeh³

2009

WJG

View full text Add to dashboard Cite

show abstract

“…In patients with non-obstructive dysphagia, there is no evidence of mechanical obstruction and the symptoms are usually attributed to oesophageal motor dysfunction.I In a significant proportion of these patients, however, routine manometric assessment fails to show any abnormality of primary peristalsis and the aetiology of the symptoms is unclear. [1][2][3][4][5] Additional tests such as radionuclide measurement of oesophageal transit6 7 or using solid boluses as a part of the manometric assessment may improve the diagnostic findings8-1" but the mechanism of the delayed oesophageal transit or clearance detected by these methods is often not explained. The implication, however, is that there is an undetected oesophageal motor abnormality.…”

mentioning

confidence: 99%

Secondary oesophageal peristalsis in patients with non-obstructive dysphagia.

Schoeman

Holloway

1994

Gut

View full text Add to dashboard Cite

Secondary peristalsis was investigated in 30 patients with non-obstructive dysphagia and 20 age matched controls. Oesophageal motility was recorded at 3 cm intervals along the oesophageal body. Primary peristalsis was tested with 5 ml water swallows. Secondary peristalsis was stimulated with 10 ml boluses of air and water injected in the midoesophagus and by distensions (5 seconds duration) with a 3 cm balloon at the same level. Primary peristalsis was normal in 19 of the 20 control subjects and in nine of the 30 patients with dysphagia; 11 patients had diffuse spasm and 10 had non-specific abnormalities of primary peristalsis. Secondary peristalsis was triggered significantly less frequently by air and water distension in dysphagia patients (median success rate of 10% for the air boluses and 0% for the water boluses) than in control subjects (50% and 30% respectively, p<0.005), and was abnormal in six of nine patients with normal primary peristalsis, nine of 11 patients with diffuse spasm and eight of 10 patients with non-specific motor abnormalities. The median frequency of balloon induced secondary peristalsis, however, was not significantly different in the two groups (0% controls, 40% nonobstructive dysphagia, p=0 22). For each stimulus, there were no significant differences in the response rate in the three subgroups of patients. The major pattern of failure of secondary peristalsis in response to the air and water boluses was the complete absence of any oesophageal response. The amplitude of complete secondary peristalsis triggered by the water boluses and the balloon was greater in the patients with dysphagia (p=003) than in normal subjects, while the amplitude of the secondary peristaltic responses triggered by the air boluses was similar in the two groups. Secondary peristaltic velocity was also similar in normal subjects and patients with nonobstructive dysphagia. Patients with non-obstructive dysphagia show a noticeable defect in the triggering of secondary peristalsis which may make an important contribution to the delayed oesophageal bolus transit and dysphagia seen in this condition.

show abstract

“…Uma possível explicação para o grupo normal apresentar disfagia, seria o fato de que, por ser um sintoma, é revestido de subjetividade, podendo sofrer variações de intensidade e localização, na dependência do estado emocional ou psicológico dos pacientes (10,16) . É preciso enfatizar que o estudo manométrico avalia um dos aspectos da peristalse esofagiana, que é o registro de contrações ou ondas que necessariamente ocluam o lúmen esofagiano e possam impressionar os sensores de um cateter ligados a transdutores de pressão (17) . Além disso, em alguns pacientes com disfagia e exame manométrico normal têm sido descritas alterações de pequena intensidade como discreto aumento de velocidade das ondas peristálticas em comparação a grupo controle assintomático (9) , hipótese que também poderia ser aventada para explicar o sintoma.…”

Section: Discussionunclassified