Esophageal Manometry and pH-Impedance Studies in Gastro-Esophageal Reflux Disease INTRODUCTION The first attempts at measuring the pH changes in Gastro-esophageal reflux disease (GORD) were made by Tuttle et al, who in 1960 used a glass pH electrode to demonstrate a gradual sloping gradient in the gastro-esophageal pH gradient in patients with esophagitis in contrast to a sharp one in normal subjects(1).Later, Johnson and DeMeester developed a dependable external electrode in 1974, successfully using it to measureesophageal pH changes for up to 24 hours(2). During the last decade, further studies demonstrated thatthe use of combined pH-impedance monitoring was more effective compared to pH monitoring alone in clinical practice. Kronecker …show more content…
Detection of periods of esophageal acidification allows for a direct diagnosis of episodes of gastro-esophageal reflux and quantification of the exposure of the distal esophagus to acid(2). For ambulatory monitoring, the basic equipment should include a data logger and an event marker to signal symptoms and other events during the period of recording. Reflux is defined as a drop in pH below 4. The number of episodes of reflux and the acid exposure time (the % of time with the pH <4) is recorded.The acid exposure time has been shown to positively correlate with the degree of mucosal damage. Although routine studies are performed with one distal pH sensor, experimental studies using multiple pH sensors allow evaluation of the proximal extent of the reflux(4). However, pH studies do not give a measurement of the volume of the reflux. Wireless pH monitoring using a capsule is a fairly recent advancement which is more tolerable to the patient, but is limited by cost. Intraluminal Impedance Monitoring Impedance monitoring includes the concurrent measurement of impedance from multiple intraluminal recording segments of an impedance catheter positioned within the esophageal body (5). The different patterns of electrical conductivity of gas, liquid or mixed content allows their distinction. It is also possible to distinguish between resting states, bolus transit, and wall contraction. The sequence of impedance changes allow
Images were obtained for the oropharynx, the whole length of the esophagus including the proximal and distal ends, and the gastroesophageal junction ( GEJ ) for any present pathology, with single and double contrast studies for mucosal relief. The images were taken while the patients were in the supine position. For upper GI endoscopy, a complete preparation was done for the patients including nothing per oral ( NPO ) for at least four hours before the start of the examination, under local anesthesia. The complications and risks of the procedure were also explained to the patients prior the exam. The patients were positioned on their left side, and to prevent them from biting on the endoscope, a mouth guard was placed between the teeth. The endoscope was moved over the tongue into the oropharynx under vision, the endoscope was guided into the esophagus with fast and gentle manipulation, noting any pathology while the endoscope was gradually advanced down the esophagus. If necessary, a biopsy was taken immediately. The result of the study was ten of the patients ( 83.34% ) were diagnosed with videofluoroscopy, and five patients ( 41% ) were diagnosed with upper GI endoscopy, however; eight of the examined patients, no problems were found on both videofluoroscopy, or upper GI endoscopy. The results showed That in comparison with the upper GI endoscopy, videofluoroscopy can accurately diagnose a large number of positive causes of dysphagia. Also, videofluoroscopy was readily done, and it did not require a previous work up of the
Antacids are taken to neutralize the acid from the stomach (What is GERD?). It is important to note that antacids taken for long periods of time can harm the kidneys by a build up of magnesium in the body and an altered calciummetabolism (What is GERD?). Some other drugs that are also recommended by doctors are H2 blockers which inhibit acid secretion in the stomach. These include Zantac and Pepcid. It is very important to treat this disease because continual acid in the esophagus will lead to other even harmful diseases. If left untreated and acid reflux continues regularly, the patient is at risk for developing other various esophagus disorders such as, ulcers, Barret’s Disease, esophagitis, and esophageal adenocarcinoma (Sonnenberg). According to an article written by Ammon Sonnonberg and Heshem B. El-Serag, esophageal adenocarcinoma causes 2.5 deaths per million people. Often the symptoms of gastroesphageal reflux disease are a poor indicator to the severity of the disease and esophageal condition. A gastrointestinal endoscopy is usually performed to determine the condition of the esophagus (Sonnenberg). This can also be used to check the lower esophageal sphincter
Gastroesophageal Reflux Disease or G.E.R.D is the result of stomach contents flowing backwards up the esophagus. This paper will discuss the symptoms of G.E.R.D., how G.E.R.D. is diagnosed, the treatment, and ways to prevent the disease. Gastroesophageal Reflux Disease is treatable with favorable results; however, if left untreated G.E.R.D can cause serious complications over time.
Gastroesophageal reflux disease (GERD) is the reflux of pepsin and acid from the stomach to the esophagus which causes esophagitis. It also causes edema, erosion, hyperemia, tissue fragility and ulcerations. Through the development of GERD, the resting quality of the lower esophageal spincter (LES) is likely to be lower
Gastro-esophageal reflux disease (GERD) is a medical condition where abnormal distal esophageal acid exposure caused by reflux of acid contents results in troublesome symptoms1, 2. It is caused by the failure of endogenous anti-reflux barriers such as the lower esophageal sphincter1. Small amounts of reflux occur naturally throughout the day in everyone but normal anatomy and physiology of the esophagus, lower esophageal sphincter, diaphragm muscles at the hiatus and stomach prevent pathological GERD3. The worldwide prevalence of GERD is estimated to be 13-19%, with 35% suffering symptoms at least monthly, 12% at least weekly and 5% daily4 though different sources have
FSSG scores reported that 33% of patients were suffering from acid reflux symptoms and 42% complained about dysmotility symptoms.
Gastroesophageal Reflux Disease, or GERD, occurs when there is a backflow of stomach contents, also known as chyme, from the stomach to the esophagus causing irritation and damage to the esophageal lining. When things are consumed by mouth, contractile motions in the esophagus move substances down the esophageal tract and into the stomach. The lower esophageal sphincter is an area of smooth muscle at the end of the esophagus that works with the diaphragm to let the food, liquid or medication into the stomach. The stomach produces acid and is constructed to withstand this acid, but the esophagus is not. Normally, the lower esophageal sphincter keeps stomach contents, including food,
A percentage of the systems that specialists use to analyze gastroesophageal reflux malady can be befuddling or hard to get it. When it comes time for you to choose which analysis strategy you might want your specialist to use for you, it would be to your greatest advantage to advise yourself about upper endoscopy, one basic procedure for heartburn
Our findings that dilatation up to more than 16 mm significantly prolonged the dysphagia-free period are only valid for benign anastomotic esophagus strictures. One should be cautious with extrapolating this evidence to other types of esophageal strictures. For instance, corrosive and radiation strictures are usually more complex with longer segments and strictures at multiple levels in the esophagus and require more careful dilatation because of a higher risk of perforation15,25,33,34. On the other hand peptic strictures nowadays may have a milder course with a recurrence rate of 30% to 63%24,35,36, which is comparable with the recurrence rate of benign anastomotic strictures10. Peptic strictures are also dilated to a luminal diameter up to
Laryngopharyngeal reflux (LPR) disease is defined as the backward flow of stomach content up to the throat. It has a wide variety of symptoms in the paedi-atric population, and is usually associated with many otolaryngological problems such as laryngitis, pharyn-gitis, rhinosinusitis, eustachian tube dysfunction, recur-
Over the past few weeks we have been studying the gastrointestinal system, as we progress thru our clinical and didactic instruction, I have learned that the alimentary canal is a long and complex structure. Although the basic positioning concepts are similar to those of the chest and abdomen, the organs of digestive system are difficult to visualize without the use of contrast media. While at Christus Spohn South, I have had the opportunity to view several esophagograms, however there has only been one upper GI series (UGI). Below I will explain the many aspects of this exam and how it is performed.
reflux events in turn may aggravate apnoeic episodes and increase its severity.11,17 Valipour et al. found that 70% of
Esophagogastroduodenoscopy (EGD) is the most widely used method to investigate esophageal diseases with excellent accuracy. Till date it has been considered the gold standard for the diagnosis and surveillance of esophageal diseases including interventional procedures. It has mainly been used for diagnosing barret’s esophagus, reflux esophagitis, esophageal varices and esophageal cancers. However the EGD is expansive and uncomfortable to the patient along with a small potential risk for complications. It involves the risk of conscious sedation along with loss of productivity. It has more complication rate in cases of cirrhosis. Next step was the development of a safer and more comfortable method to view the mucosa of esophagus thus came
Looking at adult patients, a crossover study done in Greece, by Sdravou, Walshe and Dagdilelis (2011), looked specifically at the effects of carbonated liquids versus non-carbonated liquids on swallowing in adults with neurogenic dysphagia. The hypothesis was that carbonated liquids would increase swallow efficiency and reduce risk of aspiration. There were 17 participants between the ages of 18 and 80 years old who had to meet six criteria. All participants were considered to have dysphagia with associated pulmonary disease. High-density barium sulfate mixed with deionized water was used as the solution for the liquid samples (nectar carbon thickened-liquids). The measurements of the swallow (oral transit time, pharyngeal transit time, initiation of pharyngeal swallow, pharyngeal retention) were done by videoflouroscopy. The participant’s swallow was also rated
The invention of the transistor enabled the first radio telemetry capsules, which utilized simple circuits for in vivo telemetric studies of the gastro-intestinal tract. These units could only transmit from a single sensor channel, and were difficult to assemble due to the use of discrete components. The measurement parameters consisted of temperature, pH or pressure, and the first attempts of conducting real-time noninvasive physiological measurements suffered from poor reliability, low sensitivity, and short lifetimes of the devices. The first successful pH gut profiles were achieved in 1972, with subsequent improvements in sensitivity and lifetime.