Persistent dysphagia after removal of an adjustable gastric band for morbid obesity: a rare complication

Esophageal and gastric pouch dilatations are not uncommon after laparoscopic adjustable gastric banding for morbid obesity. Most of the cases are treated by gastric band deflation or removal. We report here the case of a 44‐year‐old woman with vomiting and severe dysphagia persisting despite gastric band removal, in relation with a scar stenosis and a gastric pouch trapped in the thorax, treated by laparoscopic surgery. This case underlines the usefulness of high‐resolution manometry in the diagnostic work‐up of these often difficult cases.     

胃镜检查和高分辨率食管测压及上消化道造影检查对代谢综合征合并食管裂孔疝的临床诊断价值研究

背景 代谢综合征患者合并食管裂孔疝的诊断尚无"金标准"的检查方法，提高术前的检出率，对于制订合理的手术方式并且避免术后严重的并发症有重要意义。 目的 探究胃镜、高分辨率食管测压以及上消化道造影检查对代谢综合征合并食管裂孔疝的临床诊断价值。 方法 回顾性选取2021年9月至2022年4月新疆维吾尔自治区人民医院微创、疝与腹壁外科收治的代谢综合征合并胃食管反流并行手术治疗的患者55例，根据术中所见将患者分为代谢综合征合并食管裂孔疝组（复杂组，17例）和代谢综合征未合并食管裂孔疝组（单纯组，38例）。入院后完善胃镜检查、高分辨率食管测压、测酸以及上消化道造影检查，并采用Gerd Q评分量表进行测评。绘制不同检查方法诊断代谢综合征合并食管裂孔疝的受试者工作特征（ROC）曲线，并比较ROC曲线下面积（AUC）。 结果 复杂组胃镜诊断率、高分辨率食管测压诊断率、测压食管裂孔疝直径、上消化道造影检查诊断率、Gerd Q评分均高于单纯组，食管下括约肌静息压平均值（LESP）、Demeester评分均低于单纯组（P<0.05）。多因素Logistic回归分析结果显示，Demeester评分和上消化道造影检查是诊断代谢综合征合并食管裂管疝的影响因素（P<0.05）。ROC曲线结果显示，胃镜检查（AUC=0.728，P=0.007）、LESP（AUC=0.789，P=0.001）、Demeester评分（AUC=0.772，P=0.001）、上消化道造影检查（AUC=0.774，P=0.007）、Gerd Q评分（AUC=0.746，P=0.004）的AUC均>0.7，具有较高的临床诊断价值。 结论 胃镜检查、LESP、Demeester评分、上消化道造影检查和Gerd Q评分对代谢综合征合并食管裂孔疝具有较高的诊断价值。     

Influence of Body Position on Defecation in Humans

Objectives: To compare three positions for defecation by measuring abdominal pressure and the anorectal angle simultaneously. Methods: We recruited six healthy volunteers. The videomanometric measures included simultaneous fluoroscopic images, abdominal pressures, subtracted rectal pressures and anal sphincter pressures. Three positions were used: sitting, sitting with the hip flexing at 60 ° with respect to the rest of the body, and squatting with the hip flexing at 22.5 ° with respect to the rest of the body. Results: Basal abdominal pressure before defecation on hip‐flex sitting was lower than that with normal sitting, although the difference did not reach statistical significance. Basal abdominal pressure before defecation on squatting (26 cmH₂O) was lower than that with normal sitting (P < 0.01). Abdominal pressure increase (strain) on hip‐flex sitting was lower than that with normal sitting, although this difference did not reach statistical significance. Similarly, the abdominal pressure increase on squatting was smaller than that with normal sitting, and yet the difference did not reach statistical significance. The rectoanal angle on defecation on hip‐flex sitting did not differ from that with normal sitting. The rectoanal angle on defecation on squatting (126 °) was larger than that with normal sitting (100 °) (P < 0.05), and was also larger than that with hip‐flex sitting (99 °) (P < 0.01). Conclusion: The results of the present study suggest that the greater the hip flexion achieved by squatting, the straighter the rectoanal canal will be, and accordingly, less strain will be required for defecation.     

反流性食管炎、Barrett食管的食管动力学研究

目的 探讨反流性食管炎(RE)、Barrett食管(BE)的动力学改变。方法 经内镜检查3 400例患者,分 RE、BE、对照组,进行症状调查、食管测压、食管24h pH检测,并行统计学分析。结果 RE与BE组间除吞咽不适外,烧心感、反酸及胸骨后疼痛的症状评分均为RE组大于BE组,且差异有显著性意义。部分RE、BE、对照组间食管运动功能比较,食管下括约肌静息压等差异均无显著性意义。食管24 h pH检测DeMeester评分、pH<4总时间、pH<4时间的百分比等 RE、BE组高于对照组,差异有显著性意义,但RE、BE组间差别无显著性意义。结论 食管反流症状与食管黏膜的内镜下表现不一致;食管组织化生与食管运动功能间无相关。     

Manometric patterns of rat colonic motor activity and defecation

We investigated in conscious and unrestrained rats, the major patterns of colonic pressure waves, as related to defecation. A manometric low compliance perfusion system, which was set at a very low flow rate (0.03 ml/min), permitted simultaneous recordings of intraluminal pressure in the proximal, transverse, and distal colon. Pressure waves in control rats reflected two types of motor activity: short-duration waves (<15 sec), that were frequent throughout the colon (about 40–90/hr with aborally decreasing frequency), and propulsive, long-duration, high-amplitude waves (>15 sec, >15 mm Hg) that occurred only occasionally (1/hr or less) in the transverse and distal, but not in the proximal colon; these waves appeared to migrate aborally and were associated with defection. The serotonin 5HT_1A agonist 8-OH-DPAT dramatically and dose-dependently increased the frequency of long-duration, high-amplitude waves in the transverse and distal colon, and concurrently promoted defecation; these effects were prevented by the putative 5HT_1A antagonist pindolol. We conclude that 5HT_1A agonists such as 8-OH-DPAT may promote defecation and occurrence of propulsive waves through the same serotoninergic mechanism.A preliminary account of this work was presented at the 13th International Symposium on Gastrointestinal Motility, Kobe, Japan, Abstract 172. J Gastrointest Motil 3, 1991.     

Dysphagia after pharyngolaryngeal cancer surgery. Part I: Pathophysiology of postsurgical deglutition

Eighty-one patients were examined after laryngopharyngeal cancer surgery with a sequential computer manometry system using 4-channel-pressure probes. The general swallowing coordination is neither a matter of the oropharyngeal pressure thrust nor of the pharyngeal transit time, but mainly depends on swallowing initiation. The points of interest are both the pharyngeal inlet and outlet. The topographic correlates are the base of the tongue and the upper esophageal sphincter (UES). Resections of the base of the tongue lead to a decrease of volume available for pressure generation, thus reducing the tongue driving force. The swallowing reflex is uncoordinated resulting in dyskinesia of the UES. Compensation may be achieved with a stronger oropharyngeal thrust and/or repeated swallows. Distal resections alter the pharyngoesophageal segment so that a functional obstruction results, combined with lower pressure amplitudes in the hypopharynx, reducing the pressure gradient necessary for bolus flow. This increasing resistance can be overcome by higher propulsive forces in the base of the tongue region. In case of additional lingual defects, deglutition is subject to decompensation, highlighting the major role of the tongue as a pressure generator for bolus passage.