胆总管下端良性狭窄患者内镜下十二指肠乳头括约肌切开术前后Oddi括约肌压力变化的分析

目的 采用十二指肠Oddi括约肌（SO）测压术观察胆管下端良性狭窄患者行内镜十二指肠乳头括约肌切开术（EST）前后SO压力变化的情况。 方法 胆管下端良性狭窄患者18例于EST前后应用Oddi括约肌测压装置检测十二指肠压、胆总管压、SO基础压、收缩振幅及收缩频率等变化情况。 结果 EST前后SO基础压、收缩振幅及收缩频率等差异有显著性（P <0.05）,各种疾病间改变差异无显著性。 结论 内镜下括约肌切开后胆管下端良性狭窄患者SO压力降低,可改善患者因SO功能障碍出现的相关症状。     

Validation of the Short-Form Esophageal Hypervigilance and Anxiety Scale

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Impaired Rectoanal Inhibitory Response in Scleroderma (Systemic Sclerosis): An Association with Fecal Incontinence

Gastrointestinal abnormalities in systemic sclerosis (SSc) involve both myogenic and neural mechanisms. The aims of this study were to evaluate the rectoanal inhibitory response (RAIR) in SSc patients and to correlate RAIR with duration and subtype of disease, antibody status, and lower gastrointestinal symptoms. Thirty-five patients with SSc completed a questionnaire and underwent anorectal manometry (ARM). Forty-five patients without SSc served as controls. In the 35 SSc patients, 62.3% reported diarrhea, 57.1% reported constipation, and 37.1% reported fecal incontinence. Twenty-five of the 35 scleroderma patients (71.4%) demonstrated an impaired or absent RAIR, compared with none of the 45 controls (P < 0.001). Eleven of 13 incontinent SSc patients (84%) had an impaired RAIR. No correlation was found between RAIR and duration or subtype of SSc, antibody status, or presence of diarrhea or constipation. Impaired RAIR was closely correlated with fecal incontinence, suggesting a possible neural mechanism for maintenance of continence.     

Evaluation of vector manometry for characterization of functional outcome after restorative proctocolectomy

AIM: The impact of 3-dimensional vector manometry (VM) for characterization of the functional outcome of restorative proctocolectomy (RP) was studied in 61 patients at a median of 86 months after RP for ulcerative colitis. METHODS: A 14-day continence diary was utilized to quantify continence, urgency, and the frequency of defecation. The clinical outcome data were correlated to the physiology parameters of VM and volumetry. RESULTS: VM parameters at rest correlated with postoperative continence but not substantially with stool frequency and urgency. High radial asymmetry was significantly correlated with the degree of incontinence (r = 0.333, p = 0.013). Resting pressures demonstrated a better correlation with the degree of incontinence when documented for the high-pressure zone (HPZ; portion of the sphincter with at least 50% of the maximum pressure; r = 0.301, p = 0.025) and when performed in the continuous pull-through technique. Stool frequency and urgency were better characterized by volumetry parameters like threshold volumes and pouch compliance. The specificity and sensitivity of the vector volume at rest of the HPZ for the prediction of incontinence was 63.6% and 59.1%, respectively. The corresponding values were 67% and 68%, respectively, for radial asymmetry at rest. Stool frequency and urgency were better characterized by volumetry parameters like threshold volumes and pouch compliance. CONCLUSION: A strong anal sphincter at rest and a consistent radial distribution of the sphincter pressure are the most reliable indicators of continence after RP obtained by VM, but their clinical usefulness is limited.     

正常人和胃食管反流病人的昼夜食管pH和动力变化

目的:为探讨正常人和胃食管反流病(gastroesophageal reflux disease,GERD)病人昼夜食管运动规律以及食管运动与酸反流的关系。方法:45例GERD病人和10名正常人均接受食管测压和动态食管pH及压力同步监测。结果:(1)下食管括约肌压、远端食管蠕动压及有效食管蠕动百分比在酸反流DeMeester高计分组明显低于低计分组(P<0.05),在反流性食管炎组也明显低于非反流性食管炎组(P<0.05)。(2)有GERD症状或食管炎的卧位有效蠕动百分比明显低于立位(P<0.05)。反流性食管炎组80％有夜间或伴有夜间反流,而不伴反流性食管炎的GERD无1例出现夜间反流。结论:昼夜食管pH和压力动态监测有利于进一步探讨GERD的运动病理,除LES功能外,食管清除功能在GERD发病中起重要作用。     

Swallowing performance in patients with vocal fold motion impairment

Twenty-seven patients with vocal fold motion impairment underwent detailed pharyngoesophagel manometry with a strain gauge assembly linked to a computer recorder. Nine were known to have lesions of the central vagal trunk or nucleus, 9 had recurrent laryngeal nerve (RLN) palsy, and the remainder were idiopathic. The site of the lesion was a more important determinant of subjective swallowing performance than the position of the involved cord at laryngoscopy. Patients with cental lesions had lower tonic and contraction upper esophageal sphincter (UES) pressures than 25 age-matched controls, suggesting that high cervical branches of the lower cranial nerves are important in UES excitatory innervation. RLN palsy patients showed significantly increased pharyngeal contraction amplitude and reduced pharyngoesophageal wave durations. The results suggest that the dysphagia associated with vocal fold motion impairment is not simply due to the disruption of laryngeal deglutitive kinetics, but to independent effects on pharyngeal function.     

Transition from nutcracker esophagus to achalasia

Summary Nutcracker esophagus is essentially a manometric diagnosis characterized by high-amplitude, often prolonged duration of peristaltic contractions in the distal two thirds of the esophagus. Its association with noncardiac chest pain and/or dysphagia has been recognized and reported by numerous esophageal motility laboratories. There are very few long-term studies of the natural history of this abnormality. We report a patient who presented with dysphagia and, on initial investigation, was found to have classical nutcracker esophagus. On reinvestigation three years later, however, he had developed achalasia of the cardia. The transition from nutcracker esophagus to achalasia has not previously been reported.     

High-Resolution Manometry Thresholds and Motor Patterns Among Asymptomatic Individuals

ObjectiveHigh-resolution manometry (HRM) is the current standard for characterization of esophageal body and esophagogastric junction (EGJ) function. We aimed to examine the prevalence of abnormal esophageal motor patterns in health, and to determine optimal thresholds for software metrics across HRM systems.DesignManometry studies from asymptomatic adults were solicited from motility centers worldwide, and were manually analyzed using integrated relaxation pressure (IRP), distal latency (DL), and distal contractile integral (DCI) in standardized fashion. Normative thresholds were assessed using fifth and/or 95th percentile values. Chicago Classification v3.0 criteria were applied to determine motor patterns across HRM systems, study positions (upright vs supine), ages, and genders.ResultsOf 469 unique HRM studies (median age 28.0, range 18–79 years). 74.6% had a normal HRM pattern; none had achalasia. Ineffective esophageal motility (IEM) was the most frequent motor pattern identified (15.1% overall), followed by EGJ outflow obstruction (5.3%). Proportions with IEM were lower using stringent criteria (10.0%), especially in supine studies (7.1%–8.5%). Other motor patterns were rare (0.2%–4.1% overall) and did not vary by age or gender. DL thresholds were close to current norms across HRM systems, while IRP thresholds varied by HRM system and study position. Both fifth and 95th percentile DCI values were lower than current thresholds, both in upright and supine positions.ConclusionsMotor abnormalities are infrequent in healthy individuals and consist mainly of IEM, proportions of which are lower when using stringent criteria in the supine position. Thresholds for HRM metrics vary by HRM system and study position.     

Severe short bowel syndrome with a surgically reversed small bowel segment

Summary We report a case of short bowel syndrome (60 cm of jejunum anastomosed to the left colon) with reversal of the distal 15 cm of jejunum in a 21-year-old man. The nutritional absorptive capacity and digestive motility was studied for 18 months postoperatively. His absorptive capacity reached subnormal values allowing him oral nutritive autonomy and normal social life. The results of the manometric study suggested that the reversed segment delayed intestinal transit time. The prolonged contact of the chyme with the intestinal absorptive mucosa possibly increased its absorptive capacity.Our data and the literature reports suggest that reversal of a bowel loop could help wean patients from their dependence on parenteral nutrition.     

Influence of Bolus Consistency and Position on Esophageal High-Resolution Manometry Findings

Background Conventional esophageal manometry evaluating liquid swallows in the recumbent position measures pressure changes at a limited number of sites and does not assess motility during solid swallows in the physiologic upright position. Aim To evaluate esophageal motility abnormalities during water and bread swallows in the upright and recumbent positions using high-resolution manometry (HRM). Methods Thirty-two-channel HRM testing was performed using water (10 ml each) and bread swallows in the upright and recumbent positions. The swallows were considered normal if the distal peristaltic segment >30 mmHg was >5 cm, ineffective if the 30-mmHg pressure band was <5 cm, and simultaneous if the onset velocity of the 30 mmHg pressure band was >8 cm/s. Abnormal esophageal manometry was defined as the presence of ≥30% ineffective and/or ≥20% simultaneous contractions. Results The data from 96 patients (48 F; mean age 51 years, range 17–79) evaluated for dysphagia (56%), chest pain (22%), and gastroesophageal reflux disease (GERD) symptoms (22%) were reviewed. During recumbent water swallows, patients with dysphagia, chest pain, and GERD had a similar prevalence of motility abnormalities. During upright bread swallows, motility abnormalities were more frequent (p = 0.01) in patients with chest pain (71%) and GERD (67%) compared to patients with dysphagia (37%). Conclusions Evaluating bread swallows in the upright position reveals differences in motility abnormalities overlooked by liquid swallows alone. This work was presented as an abstract at Digestive Disease Week (DDW) 2006, Los Angeles, CA, 20–25 May 2006.