The Utility of Esophageal Motility Testing in Gastroesophageal Reflux Disease (GERD)

Garbarino, Stephanie; Horton, Anthony J.; Patel, Amit

doi:10.1007/s11894-019-0704-7

Cited by 19 publications

(7 citation statements)

References 53 publications

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“…Hence patients are often treated for other disorders including GERD before the diagnosis of achalasia is established 16. Therefore, patients with refractory GERD should undergo oesophageal manometry to exclude motility disorders such as achalasia, which is managed differently from reflux disease 17 18…”

Section: Discussionmentioning

confidence: 99%

Atypical dysphagia with end-stage oesophageal disease 30 years post Angelchik device placement in a 72-year-old man

et al. 2020

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Here we describe an atypical presentation of progressive dysphagia in a 72-year-old man leading to frequent regurgitations over the course of 30 years. Investigations revealed a foreign body ring surrounding the proximal stomach and dilation of the oesophagus proximal to the gastro-oesophageal junction. An Angelchik device was extracted; however, the patient’s rapid deterioration prior to surgery, in addition to his severely dysfunctional oesophagus, required placement of a jejunostomy feeding tube. Device removal was complicated by prior abdominal surgery, necessitating a thoracic approach. This case offers guidance on the management of patients with Angelchik prostheses who develop similar complications, while drawing attention to the importance and difficulties of early, definitive diagnosis in oesophageal pathology such as achalasia and gastro-oesophageal reflux disease.

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Section: Discussionmentioning

confidence: 99%

Atypical dysphagia with end-stage oesophageal disease 30 years post Angelchik device placement in a 72-year-old man

et al. 2020

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“…Esophageal physiologic testing utilized to differentiate behavioral disorders from GERD includes multichannel intraluminal impedance‐pH (MII‐pH) monitoring and esophageal high‐resolution impedance manometry (HRIM) 7 . MII‐pH has specifically been used to study patients with excessive belching and has been shown to identify SGB as a source of symptoms 8‐10 .…”

Section: Introductionmentioning

confidence: 99%

Diagnostic yield and reliability of post‐prandial high‐resolution manometry and impedance‐ph for detecting rumination and supragastric belching in PPI non‐responders

DeLay

Pandolfino

Roman

et al. 2021

Neurogastroenterology Motil

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Background Supragastric belching (SGB) and rumination are behavioral disorders associated with proton pump inhibitor (PPI) non‐response and can be diagnosed using multichannel intraluminal impedance‐pH (MII‐pH) and post‐prandial high‐resolution impedance manometry (PPHRIM). This pilot study compared diagnostic yield and inter‐rater agreement for SGB and rumination using MII‐pH and PPHRIM. Methods Three esophageal physiologists performed blinded interpretations of MII‐pH and PPHRIM in 22 PPI non‐responders. Raters selected from 4 diagnostic impressions (normal, GERD, behavioral disorders, GERD+behavioral disorders) without clinical context. Primary outcomes were diagnostic impressions compared against clinical gold standard impression, between raters, and between test modalities. Following a 28‐month wash‐out period, raters re‐interpreted MII‐pH with clinical context and under consensus definition of diagnostic criteria. Key Results Compared to gold standard, rater accuracy for presence of behavioral disorders ranged from 45 to 77% on MII‐pH and 45–59% on PPHRIM. On MII‐pH, inter‐rater agreement was fair for diagnosis (ĸ0.32, p < 0.01) and suboptimal for presence of behavioral disorders (ĸ0.13, p = 0.14). On PPHRIM, inter‐rater agreement was suboptimal for both diagnosis (ĸ0.03, p = 0.34) and presence of a behavioral disorder (ĸ‐0.22, p = 0.96). Inter‐rater agreement improved in post hoc MII‐pH interpretations. Rumination was more frequently identified on PPHRIM (23, 35%) compared to MII‐pH (7, 11%). Conclusions and Inferences Diagnostic accuracy and inter‐rater agreement are higher for MII‐pH than PPHRIM, and behavioral disorders are more frequently identified on PPHRIM. Identifying behavioral disorders on MII‐pH and PPHRIM has implications for clinical evaluation of PPI non‐response; clinical context is essential for accurate study interpretation. Further work is needed to standardize definitions and interpretations.

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Section: Introductionmentioning

confidence: 99%

“…Traditionally, assessment of the esophagus and other parts of the gastrointestinal (GI) tract involves endoscopy[25,39], esophageal manometry[40,41], ambulatory acid (pH) probe test[42,43] and/or radioactive imaging[44,45] in both human and small animal[20,46] models. Often these methods involve invasive intubation and ionic radiation, and thus are unsuitable for repeated measurement, physiologically confounding in our particular use case, and provide inadequate anatomic information[47,48].…”

Section: Introductionmentioning

confidence: 99%

Utilizing Multimodal Imaging to Visualize Potential Mechanism for Sudden Death in Epilepsy

Mandal¹,

Budde²,

Lawlor³

et al. 2021

Preprint

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Sudden death in epilepsy, or SUDEP, is a fatal condition that accounts for more than 4000 deaths each year. Limited clinical and preclinical data on sudden death suggests critical contributions from autonomic, cardiac, and respiratory pathways. Recent animal (rat) studies on kainic acid induced seizure models explored a potential mechanism for such sudden and severe cardiorespiratory dysregulation being linked to acid reflux induced laryngospasm. Here, we expand on those previous investigations and utilize a multimodal approach to provide visual evidence of acid reflux-initiated laryngospasm and subsequent fatal cardiorespiratory distress in seizing rats.We used systemic kainic acid to acutely induce seizure activity in Long Evans rats, under urethane anesthesia. We recorded electroencephalography (EEG), electrocardiography (ECG), chest plethysmography and esophageal pH signals during simultaneous fast MRI scans of the rat stomach and esophagus. MRI images, in conjunction with electrophysiology data were used to identify seizure progression, stomach acid movement up the esophagus, cardiorespiratory changes, and sudden death.In all cases of sudden death, esophageal pH recordings alongside MRI images visualized stomach acid movement up the esophagus. Severe cardiac (ST segment elevation), respiratory (intermittent apnea) and brain activity (EEG narrowing due to hypoxia) changes were observed only after acid reached the larynx, which strongly suggests onset of laryngospasm following acid reflux. Additionally, absence of stomach acid in the esophagus of animals that survived acute seizure, provided evidence of a causal relationship between acid reflux and sudden death. The complimentary information coming from electrophysiology and fast MRI scans provided insight into the mechanism of esophageal reflux, laryngospasm, obstructive apnea, and subsequent sudden death in seizing animals. The results carry clinical significance as they outline a potential mechanism that may be relevant to SUDEP in humans.

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The Utility of Esophageal Motility Testing in Gastroesophageal Reflux Disease (GERD)

Cited by 19 publications

References 53 publications

Atypical dysphagia with end-stage oesophageal disease 30 years post Angelchik device placement in a 72-year-old man

Atypical dysphagia with end-stage oesophageal disease 30 years post Angelchik device placement in a 72-year-old man

Diagnostic yield and reliability of post‐prandial high‐resolution manometry and impedance‐ph for detecting rumination and supragastric belching in PPI non‐responders

Utilizing Multimodal Imaging to Visualize Potential Mechanism for Sudden Death in Epilepsy

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