Gastrointestinal symptoms of patients with esophageal contraction abnormalities

Nonesophageal, gastrointestinal symptoms were sought from consecutive patients referred for esophageal manometry in order to determine the prevalence of such symptoms in relation to manometric diagnosis. Reports by 103 patients with esophageal contraction abnormalities, a cluster of manometric findings which includes the nutcracker esophagus and diffuse esophageal spasm, were compared to those by patients with the achalasia pattern (21 patients) and scleroderma esophagus (19 patients). A history of persistent (>3 months) bowel habit abnormality requiring medical attention was reported by 19% of those with contraction abnormalities and 26% of those with scleroderma esophagus but by no patient with achalasia (P<0.05 for both compared to achalasia). Patients with contraction abnormalities had complained to physicians of more gastrointestinal symptoms and had more often been diagnosed as having the irritable bowel syndrome than those with achalasia. We conclude that, with regard to gastrointestinal symptoms, patients with esophageal contraction abnormalities more closely resemble patients with a motility disorder which has the potential for diffuse symptomatic gastrointestinal involvement (scleroderma) than those with a motility disorder restricted to the esophagus (achalasia). These findings add support to the argument that functional gastrointestinal syndromes may be representative of diffuse neuromuscular derangement in the gastrointestinal tract.Supported in part by NIH grant AM 07130 from the United States Public Health Service.     

Hiatus hernia and esophageal contraction abnormalities

The relationship of hiatus hernia to esophageal motility pattern was examined in patients referred for evaluation of esophageal symptoms. Results from standard esophageal motility studies were compared with findings on barium radiography of the upper gastrointestinal tract. Of 169 patients without radiographic evidence of esophagitis, 53 (31 percent) had normal motility of the esophageal body, whereas 116 (69 percent) demonstrated esophageal contraction abnormalities, a classification that includes the pattern of diffuse esophageal spasm at the severest extreme. Hiatus hernia was significantly more common in those with contraction abnormalities (25 percent) than in those with normal patterns (8 percent) (p = 0.01). Hiatus hernia increased in prevalence with increasing severity of contraction abnormalities, such that hiatus hernia was present in nearly half of patients with the pattern typifying diffuse esophageal spasm. Thus, hiatus hernia and esophageal contraction abnormalities are associated once other associations with hiatus hernia (e.g., esophagitis and scleroderma) have been excluded. These findings may help explain the recognized relationship of esophageal symptoms to hiatus hernia in patients without significant gastroesophageal reflux.     

Low-dose trazodone for symptomatic patients with esophageal contraction abnormalities. A double-blind, placebo-controlled trial

Twenty-nine patients with esophageal symptoms and contraction abnormalities of the esophageal body completed a 6-wk, double-blind, placebo-controlled trial of trazodone (100-150 mg/day). Measures of esophageal and psychologic symptoms were completed at entry and at each follow-up visit. Esophageal manometry was repeated at the termination of the trial. Upon completion of the treatment, patients receiving trazodone (n = 15) reported a significantly greater global improvement than those receiving placebo (n = 14; p = 0.02). Although a variable clinical response was observed, the trazodone group had less residual distress over esophageal symptoms compared with the placebo group (59% +/- 9% vs. 108% +/- 19%, p = 0.03). Manometric changes observed during the course of the trial were not influenced by treatment nor by clinical response. Remarkable reductions in ratings of chest pain were reported by both treatment groups, emphasizing the importance of controlled trials when studying this patient population. We conclude that low-dose trazodone therapy can be of benefit in the management of symptomatic patients with esophageal contraction abnormalities. In addition, our findings support recent observations that manometric abnormalities characterizing this patient group may not be solely responsible for symptoms.     

Esophageal motility,heartburn, and gastroesophageal reflux: Variations in clinical presentation of esophageal dysphagia

Dysphagia is a potentially important symptom, often leading to the finding of an anatomical or motility disorder of the esophagus. Dysphagia and heartburn represent two of the most common symptoms associated with esophageal motility disorders. To explore the relationship of symptomatic esophageal dysphagia and heartburn and their association with primary esophageal motor disorders, we have performed a retrospective assessment of 1035 patient evaluations performed at our gastrointestinal laboratory. A clear statistical association of symptomatic dysphagia and heartburn was established; however, no pattern diagnostic of a specific motility disorder was discernible. A sizable fraction of our patient population with dysphagia demonstrated normal esophageal motility. A significant portion of dyspeptic patients exhibited both normal motility and acid exposure. The differences observed between the incidence of subjective symptoms and objective dysfunction may be explained in part by an altered or increased esophageal sensitivity of these patients.     

Histological abnormalities in patients with multiple esophageal webs

Two cases of multiple esophageal webs are presented. Histological evaluation of multiple esophageal biopsies revealed marked basal cell hyperplasia along the whole length of the esophagus. In one case these mucosal alterations remained unchanged during several years of follow-up.     

Evaluation of esophageal function in patients with esophageal motor abnormalities using multichannel intraluminal impedance esophageal manometry

INTRODUCTION Esophageal manometry has been considered the “gold standard” test for the evaluation of esophageal motility. Esophageal manometry allows physicians to assess peri- stalsis by using informations about the shape, amplitude and duration of the…     

Correlation between esophageal contraction amplitude and lower esophageal sphincter pressure in patients with nutcracker esophagus

Nutcracker esophagus (NE) is a primary esophageal motility disorder characterized by high-wave amplitude at the distal esophagus. The aim of this study was to analyze patients with NE and determine the relationship between distal esophageal contraction amplitude and lower esophageal sphincter (LES) pressure. Esophageal manometry tracings of patients with NE, defined as the presence of distal contraction amplitude of more than 182 mmHg after wet swallow, were analyzed. LES pressure was measured as the mean end-expiratory value. Spearman's correlation coefficient analysis was used to compare esophageal contraction amplitude with LES pressure. This comparison was also performed in patients with isolated hypertensive LES (HLES) and in subjects with normal manometry. Forty patients (25 female, 15 male; mean age 54 years) with NE were included in the study. Mean (SD) distal esophageal contraction amplitude was 230 (35.7) mmHg and mean LES pressure was 27.3 (5.7) mmHg. Esophageal contraction amplitude showed a positive correlation with LES pressure (r = 0.49, P < 0.01). In contrast, no correlation was found in patients with HLES (r = 0.21, P > 0.05) and in those with a normal manometric study (r = 0.18, P > 0.05). It is concluded that in patients with nutcracker esophagus a positive correlation exists between distal esophageal contraction amplitude and LES pressure, suggesting a diffuse hypertensive pattern involving smooth muscle at the distal esophagus and adjacent LES.     

Upper esophageal sphincter abnormalities and high-resolution esophageal manometry findings in patients with laryngopharyngeal reflux

Background: The association between laryngopharyngeal reflux (LPR) and abnormalities of upper esophageal sphincter (UES) and esophageal motility is not clearly known. High-resolution esophageal manometry (HREM) has allowed accurate measurement and evaluation of UES and esophageal function.

Goals: To evaluate the UES function and esophageal motility using HREM in patients with LPR and compare them to patients with typical gastroesophageal reflux disease (GERD).

Study: All patients evaluated for GERD or LPR symptoms with esophageal function testing including HREM, ambulatory distal pH monitoring and upper endoscopy between 2006 and 2014 were retrospectively studied (n?=?220). The study group (group A, n?=?57) consisted of patients diagnosed with LPR after comprehensive evaluation. They were compared to patients who had typical GERD symptoms only (group B, n?=?98) and patients with both GERD and LPR symptoms (group C, n?=?65).

Results: Abnormalities in UES pressures and relaxation were found in about one-third of patients in all groups. There were no significant differences between the groups. Group B had higher prevalence of abnormal esophageal motility compared to others (group A vs. B vs. C?=?20.8% vs. 28% vs. 12.5%, p?=?.029). Group B patients also had higher prevalence of Barrett’s esophagus compared to others (group A vs. B vs. C?=?0% vs.12.2% vs. 4.6%, p?=?.01). Distal pH testing revealed no significant differences between the three groups.

Conclusions: Abnormal UES function was noted in one-third of patients with LPR or GERD. However, there were no abnormalities on esophageal function testing specific for LPR.     

Dipyridamole stress thallium-201 perfusion abnormalities in patients with hypertrophic cardiomyopathy. Relationship to clinical presentation and outcome

Aims Thallium-201 perfusion abnormalities are common in patientswith hypertrophic cardiomyopathy and may be associated withan adverse prognosis in the young. The aim of this study wasto prospectively determine the relationship between thallium-201defects during dipyridamole stress to clinical presentationand outcome in a large consecutive series of patients with hypertrophiccardiomyopathy. Methods/Results Thallium-201 single photon computed tomography was performedin 216 patients with hypertrophic cardiomyopathy during dipyridamolestress (0·5mg.kg^–1). Fixed perfusion defects occurredin 25%, and reversible defects in 22%. A combination of defectswas present in 7%. Fixed defects were associated with: a historyof syncope (17 of 46 with, vs 36 of 170 without syncope, P=0·03);larger left ventricular end-diastolic (46·9±7·4mmvs 43·3±6·4mm; P=0·001) and end-systolicdimension (30·2±8·4mm vs 24·5±5·9mm,P<0·0001); increased left atrial diameter (46·1±8·1mmvs 40·5±7·7mm, P<0·0001); lowerfractional shortening (35·9±10·4% vs 43·8±8·6%,P<0·0001); and lower maximal exercise oxygen consumption(24·2±8·1ml.min^–1.kg^–1vs 29·4±8·8ml.min^–1.kg^–1,P<0·0003). Reversible defects did not correlate withsymptomatic status, but were associated with: larger left atrialdimensions (44·5±8·1mm vs 41·0±8·0mm;P=0·009) and greater maximal left ventricular wall thickness(24·0±7·0mm vs 20·6±7·0mm,P=0·003). The mean follow up time was 41±21 months,range 0·6–124. There was no association betweenany thallium-201 abnormality and disease related death in youngor adult patients. Conclusion The present study shows that fixed thallium-201 perfusion defectsdetected during dipyridamole stress in patients with hypertrophiccardiomyopathy are associated with syncope, larger left ventricularcavity dimensions and reduced exercise capacity. Although theevent rate was relatively small, there was no evidence for anassociation between thallium-201 defects and survival.     

Endocardial activation in patients with coronary artery disease: effects of regional contraction abnormalities

Endocardial mapping was performed on 16 patients undergoing coronary artery bypass surgery, and the results were correlated with ventriculography. Bipolar electrograms were recorded from 25 to 30 left ventricular (LV) endocardial sites by a specially designed probe which was inserted through the LV vent. Electrograms were evaluated for timing and presence of fragmentation. Five patients had normally contracting ventricles, four had areas of hypokinesis, six had areas of akinesis, and one had an area of dyskinesis. In each patient earliest endocardial activation was in the septum, most often the middle portion. Latest activation was in the lateral basal area in 13 patients and in the lateral apical area in three patients. Fragmented electrograms were not found in any normal or hypokinetic zones but were found in three of six akinetic segments, and in the one dyskinetic segment. These findings describe endocardial activation of the LV and the changes seen with regional contraction abnormalities.     

Study on the contraction pattern of esophageal body in 27 patients with non-cardiac chest pain

<正>Objective To analyze the differences in the contraction pattern of esophageal body in patients with different types of non-cardiac chest pain( NCCP).Methods From January 1,2019 to December 31,2020,46 NCCP patients visiting the First Affiliated Hospital of Zhejiang Chinese Medical University were selected.According to the Lyon consensus and Rome Ⅳ dignostic criteria,     

Lipodystrophy in patients with juvenile dermatomyositis--evaluation of clinical and metabolic abnormalities

OBJECTIVE: Lipodystrophy and associated metabolic abnormalities are being increasingly recognized as complications of juvenile dermatomyositis (JDM). We investigated the prevalence of lipodystrophy and the extent of metabolic abnormalities related to lipoatrophic diabetes mellitus in patients with JDM. METHODS: Twenty patients with JDM were evaluated for evidence of lipodystrophy and associated lipoatrophic diabetes mellitus. All patients underwent clinical assessment, laboratory investigations, and metabolic studies (oral glucose tolerance test, lipid studies, insulin antibodies). RESULTS: We found clinical evidence of lipodystrophy and lipoatrophic diabetes mellitus in 4 of 20 patients with JDM and metabolic abnormalities known to be associated with lipodystrophy in another 8 patients. The 20 patients with JDM were categorized as follows: Group 1 (Patients 1-4) consisted of patients with lipodystrophy and either diabetes mellitus (2 patients) or impaired glucose tolerance (2 patients); Group 2 (Patients 5-12): no lipodystrophy but abnormal glucose and/or lipid studies; Group 3 (Patients 13-20): no lipodystrophy and no abnormalities of glucose and lipid studies. CONCLUSION: We found 25% of patients with JDM have lipodystrophy, and 50% present with hypertriglyceridemia and insulin resistance. Screening for metabolic abnormalities in JDM should be included in routine followup because of the effect of lipodystrophy on longterm prognosis.     

Contraction abnormalities of the esophageal body in patients referred for manometry

A method is proposed for classifying conventional esophageal manometry findings according to the features observed in the esophageal body rather than by disease name. Patients who demonstrate increases in mean distal wave amplitude, mean distal wave duration, or number of abnormal motor responses (repetitive or simultaneous contractions) or the presence of triple-peaked waves are classified as having distal contraction abnormalities. Severity is scored by the cumulative number of these abnormalities. Of the 210 patients referred for esophageal manometry over a 23-month period, 119 (57%) were found to have one or more of the contraction abnormalities, making this the most common esophageal body manometric classification. The presence of one or two abnormalities was most common. Patients with all four abnormalities represented <5% of the referred population and, as a group, would satisfy usual manometric criteria for diffuse esophageal spasm. The proposed system allows for recognition of patients with only one or several of the manometric features typically seen in diffuse esophageal spasm and provides a method for intra- and interstudy comparison of patients with these common findings.     

O^6-甲基鸟嘌呤-DNA甲基转移酶在食管癌患者的表达及临床意义

目的 探讨DNA修复蛋白O6-甲基鸟嘌呤-DNA甲基转移酶(MGMT)在老年食管癌患者的表达及临床意义.方法 采用免疫组织化学方法检测57例食管癌标本和20例正常食管组织中MGMT的表达,并分析其与临床病理特征之间的关系.结果 MGMT在食管癌表达的阳性率(49.1%)明显低于正常组织(85.0%,P＜0.01).侵及外膜层、有淋巴结转移、Ⅲ+Ⅳ期的食管癌患者MGMT阳性率明显低于未侵及外膜层、无淋巴结转移、Ⅰ+Ⅱ期患者(P＜0.05).MGMT在食管癌表达的阳性率在年龄、性别、分化程度、肿瘤部位组间无明显差异(P＞0.05).结论 MGMT在食管癌的表达与浸润深度、淋巴结转移和临床分期有关,可作为判断食管癌预后的指标.     

Esophageal roentgenographic "abnormalities" in patients without esophageal symptoms.

Esophageal roentgenographic studies were done on 100 persons with no esophageal symptoms to determine the range of normal anatomy and motor activity. Sixty-three persons had at least one "abnormality." Fifty-eight had an hiatal hernia, 42 had rings of one sort or another, and 21 had motor disorders. The high incidence of rings which can be demonstrated by maximal distention of the lower esophagus is of special interest in view of the recent additions to knowledge of the anatomy of this area. The range of what should be considered normal roentgenographically should be widened, and the physician should interpret with caution reports of esophageal abnormalities in asymptomatic persons.