Transcutaneous cervical esophagus ultrasound in adults: Relation with ambulatory 24-h pH-monitoring and esophageal manometry

Abstract

AIM:To determine the gastroesophageal refluxate in the cervical esophagus (CE) and measure transcutaneous cervical esophageal ultrasound (TCEUS) findings [anterior wall thickness (WT) of CE, esophageal luminal diameter (ELD), esophageal diameter (ED)]; to compare TCEUS findings in the patient subgroups divided according to 24-h esophageal pH monitoring and manometry; and to investigate possible cut-off values according to the TCEUS findings as a predictor of gastroesophageal reflux (GER). METHODS:In 45/500 patients, refluxate was visualized in TCEUS. 38/45 patients underwent esophagogastroduo denoscopy (EGD), 24-h pH monitoring and manometry. RESULTS:The 38 patients were grouped according to 24-h pH monitoring as follows: Group A: GER-positive (n = 20) [Includes Group B: isolated proximal reflux (PR) (n = 6), Group C: isolated distal reflux (DR) (n = 6), and Group D: both PR/DR (n = 8)]; Group E: no reflux (n = 13); and Group F: hypersensitive esophagus (HSE) (n = 5). Groups B + D indicated total PR patients (n = 14), Groups E + F reflux-negatives with HSE (n = 18), and Groups A + F reflux-positives with HSE (n = 25). When the 38 patients were grouped according to manometry findings, 24 had normal esophageal manometry; 7 had hypotensive and 2 had hypertensive lower esophageal sphincter (LES); and 5 had ineffective esophageal motility disorder (IEM). The ELD measurement was greater in group A + F than group E (P = 0.023, 5.0 ± 1.3 vs 3.9 ± 1.4 mm). In 27/38 patients, there was at least one pathologic acid reflux and/or pathologic manometry finding. The cut-off value for ELD of 4.83 mm had 79% sensitivity and 61% specificity in predicting the PR between Groups B + D and E (AUC = 0.775, P = 0.015). CONCLUSION:Visualizing refluxate in TCEUS was useful as a pre-diagnostic tool for estimating GER or manometric pathology in 71.1% of adults in our study, but it was not diagnostic for CE WT.

Transcutaneous Cervical and Transabdominal Ultrasonography as a Diagnostic Tool in Gastroesophageal Reflux in Childhood

“…Chen et al [27] and Zhu et al [28] both showed that the normal cervical wall thickness was between 1.8 and 2.3 mm. Kacar et al [8] reported the left anterior wall thickness as 2.29 8 0.38 mm (1.57-4.0) and they found no difference between GER-and GER+ subjects. However, we found a statistically significant difference between GER-and GER+ children with respect to anterior WTCE.…”

“…Kacar et al [8] reported the cervical anteroposterior esophageal diameter as 5.5 8 12.4 mm and found no difference between GER+ and GER-subjects. We compared UED between GER-and GER+ children, and conversely we found a statistically significant difference.…”

“…During the past 2 decades, GER has been recognized more frequently because of an increased awareness of the condition and also because of the more sophisticated diagnostic techniques that have been developed for identifying the disorder [8] .…”

“…Although ambulatory 24-hour esophageal pH monitoring has a high diagnostic value, it is an invasive method, especially in children. Esophageal ultrasonography, on the other hand, is a noninvasive, readily available, repeatable, cheap and fast technique that could be commonly used in the diagnosis of GER in children [4][5][6][7][8] . Thus, it could be a noninvasive alternative in the diagnosis of GER if sufficient data are provided on what investigations to be made and their results corresponding to GER.…”

A comparison between gastroesophagheal ultrasonography vs. barium swallow in determining the pattern of gastroesophageal reflux in a pediatric population

“…hiatus hernia, malrotation) [8] along with the valuable experiences that practitioners have acquired through the years since the 1980s, ultrasonography (US) has been used as an alternative to BS in the diagnosis of GERD [9]. Esophageal US has been described as a noninvasive, readily available, repeatable, cheap, and fast technique that could be commonly used in the diagnosis and follow-up of young children with GERD [10][11][12][13][14][15]. Comparative studies of transabdominal US and BS demonstrated that US presents a higher sensitivity in the diagnosis of GERD [16,17].…”