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Peter J. Kahrilas - One of the best experts on this subject based on the ideXlab platform.
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normal functional luminal imaging probe panometry findings associate with lack of major Esophageal Motility Disorder on high resolution manometry
Clinical Gastroenterology and Hepatology, 2021Co-Authors: Alexandra J Baumann, Peter J. Kahrilas, Erica Donnan, Joseph R Triggs, Wenjun Kou, Jacqueline Prescott, Alex Decorrevont, Emily Dorian, John E Pandolfino, Dustin A CarlsonAbstract:Background & Aims A normal Esophageal response to distension on functional luminal imaging probe (FLIP) panometry during endoscopy might indicate normal Esophageal motor function. We aimed to investigate the correlation of normal FLIP panometry findings with Esophageal high-resolution manometry (HRM) and outcomes of discrepant patients. Methods We performed a retrospective study using data from a registry of patients who completed FLIP during sedated endoscopy. We identified 111 patients with normal FLIP panometry findings (mean age, 42 y; 69% female) and corresponding HRM data. A normal FLIP panometry was defined as an esophagogastric junction (EGJ) distensibility index greater than 3.0 mm2/mm Hg, an absence of repetitive retrograde contractions, and a repetitive antegrade contraction pattern that met the Rule-of-6s: ≥6 consecutive antegrade contractions of ≥6-cm in length, at a rate of 6 ± 3 contractions per minute. HRM findings were classified by the Chicago classification system version 3.0. Results HRM results were classified as normal Motility in 78 patients (70%), ineffective Esophageal Motility in 10 patients (9%), EGJ outflow obstruction in 20 patients (18%), and 3 patients (3%) as other. In patients with EGJ outflow obstruction based on HRM, the integrated relaxation pressure normalized on adjunctive swallows in 16 of 20 patients (80%), and in 8 of 9 patients (88%) who completed a barium esophagram and had normal barium clearance. Thus, although 23 of 111 patients (21%) with normal FLIP panometry had abnormal HRM findings, these HRMs often were considered to be false-positive or equivocal results. All patients with an abnormal result from HRM were treated conservatively. Conclusions In a retrospective cohort study, we found that patients with normal FLIP panometry results did not have a clinical impression of a major Esophageal motor Disorder. Normal FLIP panometry results can exclude Esophageal Motility Disorders at the time of endoscopy, possibly negating the need for HRM in select patients.
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high resolution impedance manometry parameters enhance the Esophageal Motility evaluation in non obstructive dysphagia patients without a major chicago classification Motility Disorder
Neurogastroenterology and Motility, 2017Co-Authors: Dustin A Carlson, Peter J. Kahrilas, Jan Tack, Nathalie Rommel, Taher Omari, Zhiyue Lin, Karina Starkey, John E PandolfinoAbstract:Background High-resolution impedance manometry (HRIM) allows evaluation of Esophageal bolus retention, flow, and pressurization. We aimed to perform a collaborative analysis of HRIM metrics to evaluate patients with non-obstructive dysphagia. Methods Fourteen asymptomatic controls (58% female; ages 20–50) and 41 patients (63% female; ages 24–82), 18 evaluated for dysphagia and 23 for reflux (non-dysphagia patients), with Esophageal Motility diagnoses of normal Motility or ineffective Esophageal Motility, were evaluated with HRIM and a global dysphagia symptom score (Brief Esophageal Dysphagia Questionnaire). HRIM was analyzed to assess Chicago Classification metrics, automated pressure-flow metrics, the Esophageal impedance integral (EII) ratio, and the bolus flow time (BFT). Key Results Significant symptom-metric correlations were detected only with basal EGJ pressure, EII ratio, and BFT. The EII ratio, BFT, and impedance ratio differed between controls and dysphagia patients, while the EII ratio in the upright position was the only measure that differentiated dysphagia from non-dysphagia patients. Conclusions & Inferences The EII ratio and BFT appear to offer an improved diagnostic evaluation in patients with non-obstructive dysphagia without a major Esophageal Motility Disorder. Bolus retention as measured with the EII ratio appears to carry the strongest association with dysphagia, and thus may aid in the characterization of symptomatic patients with otherwise normal manometry.
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Distal Esophageal spasm.
Dysphagia, 2012Co-Authors: Sabine Roman, Peter J. KahrilasAbstract:Distal Esophageal spasm (DES) is an uncommon Esophageal Motility Disorder associated with dysphagia and/or chest pain. Its pathophysiology implies an impairment of Esophageal inhibitory neural function. Using conventional manometry, DES was defined by the presence of simultaneous Esophageal contractions. With the introduction of high-resolution manometry and Esophageal pressure topography (EPT) in clinical practice, rapidly propagated contractions are nonspecific of Esophageal spasm. Hence, a more physiological and clinically relevant definition was proposed. Distal latency (DL) measures the period of inhibition that precedes contraction in the distal esophagus immediately proximal to the esophagogastric junction (EGJ). Premature contractions, defined as reduced DL, appeared to be much more specific for DES in EPT. Premature contractions with normal EGJ relaxation constitute DES, while premature contractions with impaired EGJ relaxation are diagnostic of spastic achalasia. Because of the interaction between DES and gastroEsophageal reflux disease, 24-h Esophageal pH monitoring should also be considered in patient evaluation. Medical treatment of DES aims to compensate for the deficient inhibitory neural function. Sildenafil, which blocks nitric oxide degradation and thus prolongs Esophageal muscle relaxation, is a promising treatment. Endoscopic injection of botulinum toxin in the Esophageal muscle is also an interesting therapeutic option. Finally, extended surgical myotomy might be discussed in extreme cases after failure of other therapeutic options.
John E Pandolfino - One of the best experts on this subject based on the ideXlab platform.
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normal functional luminal imaging probe panometry findings associate with lack of major Esophageal Motility Disorder on high resolution manometry
Clinical Gastroenterology and Hepatology, 2021Co-Authors: Alexandra J Baumann, Peter J. Kahrilas, Erica Donnan, Joseph R Triggs, Wenjun Kou, Jacqueline Prescott, Alex Decorrevont, Emily Dorian, John E Pandolfino, Dustin A CarlsonAbstract:Background & Aims A normal Esophageal response to distension on functional luminal imaging probe (FLIP) panometry during endoscopy might indicate normal Esophageal motor function. We aimed to investigate the correlation of normal FLIP panometry findings with Esophageal high-resolution manometry (HRM) and outcomes of discrepant patients. Methods We performed a retrospective study using data from a registry of patients who completed FLIP during sedated endoscopy. We identified 111 patients with normal FLIP panometry findings (mean age, 42 y; 69% female) and corresponding HRM data. A normal FLIP panometry was defined as an esophagogastric junction (EGJ) distensibility index greater than 3.0 mm2/mm Hg, an absence of repetitive retrograde contractions, and a repetitive antegrade contraction pattern that met the Rule-of-6s: ≥6 consecutive antegrade contractions of ≥6-cm in length, at a rate of 6 ± 3 contractions per minute. HRM findings were classified by the Chicago classification system version 3.0. Results HRM results were classified as normal Motility in 78 patients (70%), ineffective Esophageal Motility in 10 patients (9%), EGJ outflow obstruction in 20 patients (18%), and 3 patients (3%) as other. In patients with EGJ outflow obstruction based on HRM, the integrated relaxation pressure normalized on adjunctive swallows in 16 of 20 patients (80%), and in 8 of 9 patients (88%) who completed a barium esophagram and had normal barium clearance. Thus, although 23 of 111 patients (21%) with normal FLIP panometry had abnormal HRM findings, these HRMs often were considered to be false-positive or equivocal results. All patients with an abnormal result from HRM were treated conservatively. Conclusions In a retrospective cohort study, we found that patients with normal FLIP panometry results did not have a clinical impression of a major Esophageal motor Disorder. Normal FLIP panometry results can exclude Esophageal Motility Disorders at the time of endoscopy, possibly negating the need for HRM in select patients.
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high resolution impedance manometry parameters enhance the Esophageal Motility evaluation in non obstructive dysphagia patients without a major chicago classification Motility Disorder
Neurogastroenterology and Motility, 2017Co-Authors: Dustin A Carlson, Peter J. Kahrilas, Jan Tack, Nathalie Rommel, Taher Omari, Zhiyue Lin, Karina Starkey, John E PandolfinoAbstract:Background High-resolution impedance manometry (HRIM) allows evaluation of Esophageal bolus retention, flow, and pressurization. We aimed to perform a collaborative analysis of HRIM metrics to evaluate patients with non-obstructive dysphagia. Methods Fourteen asymptomatic controls (58% female; ages 20–50) and 41 patients (63% female; ages 24–82), 18 evaluated for dysphagia and 23 for reflux (non-dysphagia patients), with Esophageal Motility diagnoses of normal Motility or ineffective Esophageal Motility, were evaluated with HRIM and a global dysphagia symptom score (Brief Esophageal Dysphagia Questionnaire). HRIM was analyzed to assess Chicago Classification metrics, automated pressure-flow metrics, the Esophageal impedance integral (EII) ratio, and the bolus flow time (BFT). Key Results Significant symptom-metric correlations were detected only with basal EGJ pressure, EII ratio, and BFT. The EII ratio, BFT, and impedance ratio differed between controls and dysphagia patients, while the EII ratio in the upright position was the only measure that differentiated dysphagia from non-dysphagia patients. Conclusions & Inferences The EII ratio and BFT appear to offer an improved diagnostic evaluation in patients with non-obstructive dysphagia without a major Esophageal Motility Disorder. Bolus retention as measured with the EII ratio appears to carry the strongest association with dysphagia, and thus may aid in the characterization of symptomatic patients with otherwise normal manometry.
Pinghuei Tseng - One of the best experts on this subject based on the ideXlab platform.
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pressure impedance analysis assist the diagnosis and classification of ineffective Esophageal Motility Disorder
Journal of Gastroenterology and Hepatology, 2020Co-Authors: Ijung Tsai, Tzuwei Tong, Yicheng Lin, Chiahsiang Yang, Pinghuei TsengAbstract:BACKGROUND AND AIM We elucidated the clinical significance of distal contractile integral-to-Esophageal impedance integral (EII) ratio (DCIIR) in ineffective Esophageal Motility (IEM) adult patients. METHODS We recruited 101 patients with IEM (48.38 ± 1.58 years) and 42 matched healthy volunteers (44.28 ± 1.85 years) in this case-control study. All subjects underwent Esophageal high-resolution impedance manometry from October 2014 to May 2018. The diagnosis of IEM was based on the Chicago Classification version 3.0. The EII, EII ratio, and DCIIR were analyzed by matlab software. RESULTS The EII, EII ratio, and DCIIR calculated at an impedance threshold of 1500 Ω (EII1500, EII ratio1500, and DCIIR1500, respectively) were significantly lower in the IEM group than in healthy controls (P 71 000 Ω.s.cm, and EII ratio1500 > 0.43 were all predictive of IEM. Only DCIIR1500 < 0.008 mmHg/Ω remained significant in diagnosing IEM in the multivariate logistic regression analysis (odds ratio = 72.13, P < 0.001). The DCIIR1500 is negatively correlated with Eckardt score and the Reflux Disease Questionnaire (correlation coefficient = -0.2844 and -0.3136; P = 0.0006 and 0.0002, respectively). Receiver operating characteristic analysis further showed that a DCIIR1500 cut-off of 0.002 mmHg/Ω achieved the best differentiation between the IEM-alternans and IEM-persistens subtypes among IEM patients (P < 0.001). CONCLUSIONS The novel pressure-impedance parameter of high-resolution impedance manometry, DCIIR1500, may assist in the diagnosis and classification of IEM and correlated with clinical symptoms.
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distal contractile to impedance integral ratio assist the diagnosis of pediatric ineffective Esophageal Motility Disorder
Pediatric Research, 2018Co-Authors: Chieh Chung, Yicheng Lin, Pinghuei Tseng, Jung I Tsai, Chiahsiang YangAbstract:We investigated the diagnostic utility of distal contractile integral (DCI) to Esophageal impedance integral (EII) ratio (DCIIR) in high-resolution impedance manometry (HRIM) of ineffective Esophageal Motility (IEM) in children. We performed HRIM in 31 children with dysphagia, odynophagia, chronic vomiting, chest pain, or heartburn sensation. Based on the Chicago classification version 3.0, 20 subjects were diagnosed with IEM, and 11 subjects were normal. We analyzed the EII and DCIIR using MATLAB software. The DCIIR calculated at the impedance cutoff at 1500 Ω (DCIIR1500) were significantly lower in IEM group than patients with normal Motility (P = 0.007). Receiver operating characteristic (ROC) curve analysis showed that a DCIIR1500 10% within 6 months in children. (P < 0.001). The calculation of DCIIR1500 may assist the automatic analysis of bolus transit in HRIM study to diagnose IEM in children. An DCIIR1500 < 0.009 mmHg/Ω may assist in the diagnosis of IEM in children, and DCIIR1500 < 0.008 mmHg/Ω correlated with significant body weight loss. The calculation of DCIIR may serve as possible parameters for HRIM.
Dustin A Carlson - One of the best experts on this subject based on the ideXlab platform.
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normal functional luminal imaging probe panometry findings associate with lack of major Esophageal Motility Disorder on high resolution manometry
Clinical Gastroenterology and Hepatology, 2021Co-Authors: Alexandra J Baumann, Peter J. Kahrilas, Erica Donnan, Joseph R Triggs, Wenjun Kou, Jacqueline Prescott, Alex Decorrevont, Emily Dorian, John E Pandolfino, Dustin A CarlsonAbstract:Background & Aims A normal Esophageal response to distension on functional luminal imaging probe (FLIP) panometry during endoscopy might indicate normal Esophageal motor function. We aimed to investigate the correlation of normal FLIP panometry findings with Esophageal high-resolution manometry (HRM) and outcomes of discrepant patients. Methods We performed a retrospective study using data from a registry of patients who completed FLIP during sedated endoscopy. We identified 111 patients with normal FLIP panometry findings (mean age, 42 y; 69% female) and corresponding HRM data. A normal FLIP panometry was defined as an esophagogastric junction (EGJ) distensibility index greater than 3.0 mm2/mm Hg, an absence of repetitive retrograde contractions, and a repetitive antegrade contraction pattern that met the Rule-of-6s: ≥6 consecutive antegrade contractions of ≥6-cm in length, at a rate of 6 ± 3 contractions per minute. HRM findings were classified by the Chicago classification system version 3.0. Results HRM results were classified as normal Motility in 78 patients (70%), ineffective Esophageal Motility in 10 patients (9%), EGJ outflow obstruction in 20 patients (18%), and 3 patients (3%) as other. In patients with EGJ outflow obstruction based on HRM, the integrated relaxation pressure normalized on adjunctive swallows in 16 of 20 patients (80%), and in 8 of 9 patients (88%) who completed a barium esophagram and had normal barium clearance. Thus, although 23 of 111 patients (21%) with normal FLIP panometry had abnormal HRM findings, these HRMs often were considered to be false-positive or equivocal results. All patients with an abnormal result from HRM were treated conservatively. Conclusions In a retrospective cohort study, we found that patients with normal FLIP panometry results did not have a clinical impression of a major Esophageal motor Disorder. Normal FLIP panometry results can exclude Esophageal Motility Disorders at the time of endoscopy, possibly negating the need for HRM in select patients.
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high resolution impedance manometry parameters enhance the Esophageal Motility evaluation in non obstructive dysphagia patients without a major chicago classification Motility Disorder
Neurogastroenterology and Motility, 2017Co-Authors: Dustin A Carlson, Peter J. Kahrilas, Jan Tack, Nathalie Rommel, Taher Omari, Zhiyue Lin, Karina Starkey, John E PandolfinoAbstract:Background High-resolution impedance manometry (HRIM) allows evaluation of Esophageal bolus retention, flow, and pressurization. We aimed to perform a collaborative analysis of HRIM metrics to evaluate patients with non-obstructive dysphagia. Methods Fourteen asymptomatic controls (58% female; ages 20–50) and 41 patients (63% female; ages 24–82), 18 evaluated for dysphagia and 23 for reflux (non-dysphagia patients), with Esophageal Motility diagnoses of normal Motility or ineffective Esophageal Motility, were evaluated with HRIM and a global dysphagia symptom score (Brief Esophageal Dysphagia Questionnaire). HRIM was analyzed to assess Chicago Classification metrics, automated pressure-flow metrics, the Esophageal impedance integral (EII) ratio, and the bolus flow time (BFT). Key Results Significant symptom-metric correlations were detected only with basal EGJ pressure, EII ratio, and BFT. The EII ratio, BFT, and impedance ratio differed between controls and dysphagia patients, while the EII ratio in the upright position was the only measure that differentiated dysphagia from non-dysphagia patients. Conclusions & Inferences The EII ratio and BFT appear to offer an improved diagnostic evaluation in patients with non-obstructive dysphagia without a major Esophageal Motility Disorder. Bolus retention as measured with the EII ratio appears to carry the strongest association with dysphagia, and thus may aid in the characterization of symptomatic patients with otherwise normal manometry.
Chiahsiang Yang - One of the best experts on this subject based on the ideXlab platform.
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pressure impedance analysis assist the diagnosis and classification of ineffective Esophageal Motility Disorder
Journal of Gastroenterology and Hepatology, 2020Co-Authors: Ijung Tsai, Tzuwei Tong, Yicheng Lin, Chiahsiang Yang, Pinghuei TsengAbstract:BACKGROUND AND AIM We elucidated the clinical significance of distal contractile integral-to-Esophageal impedance integral (EII) ratio (DCIIR) in ineffective Esophageal Motility (IEM) adult patients. METHODS We recruited 101 patients with IEM (48.38 ± 1.58 years) and 42 matched healthy volunteers (44.28 ± 1.85 years) in this case-control study. All subjects underwent Esophageal high-resolution impedance manometry from October 2014 to May 2018. The diagnosis of IEM was based on the Chicago Classification version 3.0. The EII, EII ratio, and DCIIR were analyzed by matlab software. RESULTS The EII, EII ratio, and DCIIR calculated at an impedance threshold of 1500 Ω (EII1500, EII ratio1500, and DCIIR1500, respectively) were significantly lower in the IEM group than in healthy controls (P 71 000 Ω.s.cm, and EII ratio1500 > 0.43 were all predictive of IEM. Only DCIIR1500 < 0.008 mmHg/Ω remained significant in diagnosing IEM in the multivariate logistic regression analysis (odds ratio = 72.13, P < 0.001). The DCIIR1500 is negatively correlated with Eckardt score and the Reflux Disease Questionnaire (correlation coefficient = -0.2844 and -0.3136; P = 0.0006 and 0.0002, respectively). Receiver operating characteristic analysis further showed that a DCIIR1500 cut-off of 0.002 mmHg/Ω achieved the best differentiation between the IEM-alternans and IEM-persistens subtypes among IEM patients (P < 0.001). CONCLUSIONS The novel pressure-impedance parameter of high-resolution impedance manometry, DCIIR1500, may assist in the diagnosis and classification of IEM and correlated with clinical symptoms.
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distal contractile to impedance integral ratio assist the diagnosis of pediatric ineffective Esophageal Motility Disorder
Pediatric Research, 2018Co-Authors: Chieh Chung, Yicheng Lin, Pinghuei Tseng, Jung I Tsai, Chiahsiang YangAbstract:We investigated the diagnostic utility of distal contractile integral (DCI) to Esophageal impedance integral (EII) ratio (DCIIR) in high-resolution impedance manometry (HRIM) of ineffective Esophageal Motility (IEM) in children. We performed HRIM in 31 children with dysphagia, odynophagia, chronic vomiting, chest pain, or heartburn sensation. Based on the Chicago classification version 3.0, 20 subjects were diagnosed with IEM, and 11 subjects were normal. We analyzed the EII and DCIIR using MATLAB software. The DCIIR calculated at the impedance cutoff at 1500 Ω (DCIIR1500) were significantly lower in IEM group than patients with normal Motility (P = 0.007). Receiver operating characteristic (ROC) curve analysis showed that a DCIIR1500 10% within 6 months in children. (P < 0.001). The calculation of DCIIR1500 may assist the automatic analysis of bolus transit in HRIM study to diagnose IEM in children. An DCIIR1500 < 0.009 mmHg/Ω may assist in the diagnosis of IEM in children, and DCIIR1500 < 0.008 mmHg/Ω correlated with significant body weight loss. The calculation of DCIIR may serve as possible parameters for HRIM.