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Peter J. Kahrilas - One of the best experts on this subject based on the ideXlab platform.
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esophageal motility disorders on High Resolution Manometry chicago classification version 4 0
Neurogastroenterology and Motility, 2021Co-Authors: Rena Yadlapati, Peter J. Kahrilas, Albert J Bredenoord, Sabine Roman, Prakash C Gyawali, Mark A Fox, Arash Babaei, Ravinder K MittalAbstract:Chicago Classification v4.0 (CCv4.0) is the updated classification scheme for esophageal motility disorders using metrics from High-Resolution Manometry (HRM). Fifty-two diverse international experts separated into seven working subgroups utilized formal validated methodologies over two-years to develop CCv4.0. Key updates in CCv.4.0 consist of a more rigorous and expansive HRM protocol that incorporates supine and upright test positions as well as provocative testing, a refined definition of esophagogastric junction (EGJ) outflow obstruction (EGJOO), more stringent diagnostic criteria for ineffective esophageal motility and description of baseline EGJ metrics. Further, the CCv4.0 sought to define motility disorder diagnoses as conclusive and inconclusive based on associated symptoms, and findings on provocative testing as well as supportive testing with barium esophagram with tablet and/or functional lumen imaging probe. These changes attempt to minimize ambiguity in prior iterations of Chicago Classification and provide more standardized and rigorous criteria for patterns of disorders of peristalsis and obstruction at the EGJ.
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benchmarks for the interpretation of esophageal High Resolution Manometry
Neurogastroenterology and Motility, 2017Co-Authors: Rena Yadlapati, Peter J. Kahrilas, Andrew J Gawron, C P Gyawali, Rajesh N Keswani, Kerry B Dunbar, Philip O Katz, David A Katzka, Stuart J Spechler, Roger P TatumAbstract:Background Competent interpretation of esophageal High-Resolution Manometry (HRM) is integral to a quality study. Currently, methods to assess physician competency for the interpretation of esophageal HRM do not exist. The aim of this study was to use formal techniques to (i) develop an HRM interpretation exam, and (ii) establish minimum competence benchmarks for HRM interpretation skills at the trainee, physician interpreter, and master level. Methods A total of 29 physicians from 8 academic centers participated in the study: 9 content experts separated into 2 study groups—expert test-takers (n=7) and judges (n=2), and 20 HRM inexperienced trainees (“trainee test-taker”; n=20). We designed the HRM interpretation exam based on expert consensus. Expert and trainee test-takers (n=27) completed the exam. According to the modified Angoff method, the judges reviewed the test-taker performance and established minimum competency cut scores for HRM interpretation skills. Key Results The HRM interpretation exam consists of 22 HRM cases with 8 HRM interpretation skills per case: identification of pressure inversion point, hiatal hernia >3 cm, integrated relaxation pressure, distal contractile integral, distal latency, peristaltic integrity, pressurization pattern, and diagnosis. Based on the modified Angoff method, minimum cut scores for HRM interpretation skills at the trainee, physician interpreter, and master level ranged from 65–80%, 85–90% (with the exception of peristaltic integrity), and 90–95%, respectively. Conclusions & Inferences Using a formal standard setting technique, we established minimum cut scores for eight HRM interpretation skills across interpreter levels. This examination and associated cut scores can be applied in clinical practice to judge competency.
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calculation of esophagogastric junction vector volume using three dimensional High Resolution Manometry
Diseases of The Esophagus, 2015Co-Authors: Zhiyue Lin, John E. Pandolfino, Frederic Nicodeme, Nathaniel J Soper, Peter J. KahrilasAbstract:Lower esophageal sphincter vector volume (V-V) was developed in the late 1980s by Bombeck, as a quantification of sphincter integrity used to select reflux patients with a defective valve who may benefit from surgery. Its calculation required motorized pull-through of an 8-lumen water perfused Manometry catheter with subsequent computerized reconstruction of sphincter morphology. Recently, a three-dimensional High-Resolution Manometry (3D-HRM) assembly (Given Imaging, Duluth, GA, USA) has been developed with the potential to assess real-time V-V. The aim of this study was to assess the feasibility of the calculation of V-V using the 3D-HRM assembly and to compare measures of its value using real-time 3D-HRM to simulated analogous measures. Eight asymptomatic controls (4F, ages 26-49) were studied in a supine position with a solid-state 3D-HRM assembly positioned across the esophagogastric junction (EGJ). The 9-cm 3D segment comprised 12 rings of 8 radially dispersed pressure sensors, each 2.5 mm long and spaced 7.5 mm apart on center. Recordings were done during normal respiration: (i) with the 3D-HRM segment in a stationary position across the EGJ; and (ii) during a station pull-through of the 3D-HRM segment withdrawing it across the EGJ at 5-mm increments with each position held for 30 seconds. EGJ cross-sectional vector areas (CSVAs) were computed using the irregular polygon area formula: [Formula in text], and n = 8 radial sensors. V-V was computed as the sum of CSVAs at inspiration and end-expiration by three methods: real-time 3D-HRM, three-station composite, and single-sensor ring measurements. There were no statistic differences among the methods, and all methods showed significant differences between inspiration and expiration. Calculation of real-time V-V is feasible using the 3D-HRM. Moreover, the results of this study Highlighted the potential primary role of the diaphragmatic hiatus in the pathophysiology of gastroesophageal reflux disease and the underrecognized but crucial role of the crural repair during the antireflux surgery.
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normative values in esophageal High Resolution Manometry
Neurogastroenterology and Motility, 2015Co-Authors: T V K Herregods, Peter J. Kahrilas, Sabine Roman, Andre J P M Smout, A J BredenoordAbstract:Background Esophageal High-Resolution Manometry (HRM) has rapidly gained much popularity worldwide. The Chicago Classification for esophageal motility disorders is based on a set of normative values for key metrics that was obtained using one of the commercially available HRM systems. Thus, it is of great importance to evaluate whether these normative values can be used for other HRM systems as well. Purpose In this review, we describe the presently available HRM systems, the currently known normative thresholds and the factors that influence them, and assess the use of these thresholds. Numerous factors including the type of HRM system, demographic factors, catheter diameter, body position during testing, consistency of bolus swallows, and esophageal length have an influence on the normative data. It would thus be ideal to have different sets of normal values for each of these factors, yet at the moment the amount of normative data is limited. We suggest broadening the normal range for parameters, as this would allow abnormal values to be of more significance. In addition, we suggest conducting studies to assess the physiological relevance of abnormal values and stress that for each system different normative thresholds may apply.
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assessing bolus retention in achalasia using High Resolution Manometry with impedance a comparator study with timed barium esophagram
The American Journal of Gastroenterology, 2014Co-Authors: Anna Lipowska, Peter J. Kahrilas, Frederic Nicodeme, Ezra N Teitelbaum, Eric S Hungness, Elyse Johnston, Andrew J Gawron, John E. PandolfinoAbstract:Assessing Bolus Retention in Achalasia Using High-Resolution Manometry With Impedance: A Comparator Study With Timed Barium Esophagram
John E. Pandolfino - One of the best experts on this subject based on the ideXlab platform.
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esophageal diverticula are associated with propagating peristalsis a study utilizing High Resolution Manometry
Neurogastroenterology and Motility, 2016Co-Authors: Dustin A. Carlson, Zhiyue Lin, Adam B Gluskin, Benjamin Mogni, J Koo, R Sood, John E. PandolfinoAbstract:Background Esophageal diverticula have been associated with esophageal motility disorders, most commonly achalasia. We aimed to evaluate High-Resolution Manometry (HRM) motility diagnoses and pressurization patterns in patients with esophageal diverticula. Methods Patients were retrospectively identified for distal esophageal diverticula and previously completed HRM. High-Resolution manometries were analyzed according to the Chicago Classification, and the pressure slope of the compartmentalization phase (time between upper esophageal sphincter closure and the transition zone) of esophageal bolus transit was measured. Pressure slopes were also measured in 10 asymptomatic volunteers (controls) for comparison. Key Results Nineteen patients (ages 31–83) were included. Eight (42%) patients had normal motility, five (26%) had esophagogastric junction outflow obstruction, and two (11%) had jackhammer esophagus; four patients had other motility diagnoses including only one patient with achalasia. A total of six patients (32%) had at least one hypercontractile swallow. Greater compartmentalization phase pressure slopes were observed in patients at the mid-esophageal body in both supine (median [interquartile range]: 1.9 mmHg/s [0.9, 3.6]) and upright (1.1 [0.1, 3.1]) positions than in controls (supine: −1.3 [−2.4, −0.11], p = 0.001; upright; −0.71 [−2.1, −0.02], p = 0.005). Conclusions & Inferences Propagating peristalsis, often with hypercontractility, was commonly seen in our cohort of patients with esophageal diverticula. Abnormal compartmentalization phase pressurization may indicate a relationship of abnormal esophageal wall mechanics and/or compliance with diverticula; however whether these findings are causal or reactionary remains unclear.
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the association between systemic sclerosis disease manifestations and esophageal High Resolution Manometry parameters
Neurogastroenterology and Motility, 2016Co-Authors: Jessica Kimmel, Dustin A. Carlson, Monique Hinchcliff, Mary Carns, Kathleen Aren, Jungwha Lee, John E. PandolfinoAbstract:Background We aimed to evaluate the associations between systemic sclerosis (SSc)-related systemic manifestations and esophageal function using High-Resolution Manometry (HRM). Methods Patients with SSc that had undergone HRM between 1/2004 and 9/2014 were identified and HRMs were analyzed according to the Chicago Classification. Clinical characteristics were identified via retrospective chart review and compared among motility diagnoses while adjusting for age, gender, race, and SSc-disease duration. Key Results Seventy-nine patients (85% female, ages 25–77) were included. Clinical characteristics were compared between patients with absent contractility (AC, n = 40), ineffective esophageal motility (IEM; n = 15), and normal motility (n = 19); the five remaining patients met criteria for other motility diagnoses. Groups differed in severity of skin involvement measured by the modified Rodnan skin score (0–51): AC (adjusted mean 12.6), IEM (4.4), normal (4.3), p = 0.043. Pulmonary function tests [percent predicted FVC and DLCO) were lower in AC (adjusted mean, FVC: 70.3, DLCO 51.1), than IEM (FVC: 92.0; DLCO: 76.9) and normal motility (FVC: 80.0; DLCO: 67.2), p values 0.057 (FVC) and 0.007 (DLCO). Groups did not differ by SSc-disease duration, autoantibodies, or reported symptoms of dysphagia or reflux. Conclusions & Inferences In patients with SSc, absent esophageal contractility on HRM was associated with increased skin disease severity and worse lung function. Obtaining HRM to identify SSc patients with more severe esophageal dysfunction could be considered to enable implementation of management strategies in patients potentially at risk for increased morbidity and mortality.
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calculation of esophagogastric junction vector volume using three dimensional High Resolution Manometry
Diseases of The Esophagus, 2015Co-Authors: Zhiyue Lin, John E. Pandolfino, Frederic Nicodeme, Nathaniel J Soper, Peter J. KahrilasAbstract:Lower esophageal sphincter vector volume (V-V) was developed in the late 1980s by Bombeck, as a quantification of sphincter integrity used to select reflux patients with a defective valve who may benefit from surgery. Its calculation required motorized pull-through of an 8-lumen water perfused Manometry catheter with subsequent computerized reconstruction of sphincter morphology. Recently, a three-dimensional High-Resolution Manometry (3D-HRM) assembly (Given Imaging, Duluth, GA, USA) has been developed with the potential to assess real-time V-V. The aim of this study was to assess the feasibility of the calculation of V-V using the 3D-HRM assembly and to compare measures of its value using real-time 3D-HRM to simulated analogous measures. Eight asymptomatic controls (4F, ages 26-49) were studied in a supine position with a solid-state 3D-HRM assembly positioned across the esophagogastric junction (EGJ). The 9-cm 3D segment comprised 12 rings of 8 radially dispersed pressure sensors, each 2.5 mm long and spaced 7.5 mm apart on center. Recordings were done during normal respiration: (i) with the 3D-HRM segment in a stationary position across the EGJ; and (ii) during a station pull-through of the 3D-HRM segment withdrawing it across the EGJ at 5-mm increments with each position held for 30 seconds. EGJ cross-sectional vector areas (CSVAs) were computed using the irregular polygon area formula: [Formula in text], and n = 8 radial sensors. V-V was computed as the sum of CSVAs at inspiration and end-expiration by three methods: real-time 3D-HRM, three-station composite, and single-sensor ring measurements. There were no statistic differences among the methods, and all methods showed significant differences between inspiration and expiration. Calculation of real-time V-V is feasible using the 3D-HRM. Moreover, the results of this study Highlighted the potential primary role of the diaphragmatic hiatus in the pathophysiology of gastroesophageal reflux disease and the underrecognized but crucial role of the crural repair during the antireflux surgery.
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assessing bolus retention in achalasia using High Resolution Manometry with impedance a comparator study with timed barium esophagram
The American Journal of Gastroenterology, 2014Co-Authors: Anna Lipowska, Peter J. Kahrilas, Frederic Nicodeme, Ezra N Teitelbaum, Eric S Hungness, Elyse Johnston, Andrew J Gawron, John E. PandolfinoAbstract:Assessing Bolus Retention in Achalasia Using High-Resolution Manometry With Impedance: A Comparator Study With Timed Barium Esophagram
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High-Resolution Manometry and Esophageal Pressure Topography: Filling the Gaps of Convention Manometry
Gastroenterology clinics of North America, 2012Co-Authors: Dustin A. Carlson, John E. PandolfinoAbstract:Although conventional Manometry set the basis for the diagnosis of esophageal motility disorders, the large axial spacing between recording sites leaves large portions of the esophagus unevaluated and vulnerable to movement artifact. However, continuous spatiotemporal representations of pressure through the esophagus recorded with High-Resolution Manometry offers greater detail and improved accuracy for many of the most important measurements of esophageal motor function. This review describes how the new classification schemes for esophageal pressure topography have evolved from conventional criteria and focuses on how esophageal pressure topography has improved the ability to subcategorize conventional manometric diagnoses into new functional phenotypes.
Albert J Bredenoord - One of the best experts on this subject based on the ideXlab platform.
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esophageal motility disorders on High Resolution Manometry chicago classification version 4 0
Neurogastroenterology and Motility, 2021Co-Authors: Rena Yadlapati, Peter J. Kahrilas, Albert J Bredenoord, Sabine Roman, Prakash C Gyawali, Mark A Fox, Arash Babaei, Ravinder K MittalAbstract:Chicago Classification v4.0 (CCv4.0) is the updated classification scheme for esophageal motility disorders using metrics from High-Resolution Manometry (HRM). Fifty-two diverse international experts separated into seven working subgroups utilized formal validated methodologies over two-years to develop CCv4.0. Key updates in CCv.4.0 consist of a more rigorous and expansive HRM protocol that incorporates supine and upright test positions as well as provocative testing, a refined definition of esophagogastric junction (EGJ) outflow obstruction (EGJOO), more stringent diagnostic criteria for ineffective esophageal motility and description of baseline EGJ metrics. Further, the CCv4.0 sought to define motility disorder diagnoses as conclusive and inconclusive based on associated symptoms, and findings on provocative testing as well as supportive testing with barium esophagram with tablet and/or functional lumen imaging probe. These changes attempt to minimize ambiguity in prior iterations of Chicago Classification and provide more standardized and rigorous criteria for patterns of disorders of peristalsis and obstruction at the EGJ.
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clinical application of esophageal High Resolution Manometry in the diagnosis of esophageal motility disorders
Journal of Neurogastroenterology and Motility, 2015Co-Authors: Froukje B Van Hoeij, Albert J BredenoordAbstract:Esophageal High-Resolution Manometry (HRM) is replacing conventional Manometry in the clinical evaluation of patients with esophageal symptoms, especially dysphagia. The introduction of HRM gave rise to new objective metrics and recognizable patterns of esophageal motor function, requiring a new classification scheme: the Chicago classification. HRM measurements are more detailed and more easily performed compared to conventional Manometry. The visual presentation of acquired data improved the analysis and interpretation of esophageal motor function. This led to a more sensitive, accurate, and objective analysis of esophageal motility. In this review we discuss how HRM changed the way we define and categorize esophageal motility disorders. Moreover, we discuss the clinical applications of HRM for each esophageal motility disorder separately.
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water perfused esophageal High Resolution Manometry normal values and validation
American Journal of Physiology-gastrointestinal and Liver Physiology, 2014Co-Authors: Boudewijn F. Kessing, Andre J P M Smout, Pim W Weijenborg, Sem Hillenius, Albert J BredenoordAbstract:Water-perfused High-Resolution Manometry (HRM) catheters with 36 unidirectional pressure channels have recently been developed, but normal values are not yet available. Furthermore, the technique has not been validated and compared with solid-state HRM. We therefore aimed to develop normal values for water-perfused HRM and to assess the level of agreement between water-perfused HRM and solid-state HRM. We included 50 healthy volunteers (mean age 35 yr, range 21-64 yr; 15 women, 35 men). Water-perfused HRM and solid-state HRM were performed in a randomized order. Normal values were calculated as 5th and 95th percentile ranges, and agreement between the two systems was assessed with intraclass correlation coefficient (ICC) statistics. The 5th-95th percentile range was 3.0-6.6 cm/s for contractile front velocity (CFV), 141.6-3,674 mmHg·s·cm for distal contractile integral (DCI), 6.2-8.7 s for distal contraction latency (DL), and 1.0-18.8 mmHg for integrated relaxation pressure (IRP 4s). Mean (SD) and ICC for water-perfused HRM and solid-state HRM were 4.4 (1.1) vs. 3.9 (0.9) cm/s, ICC: 0.49 for CFV; 1,189 (1,023) vs. 1,092 (1,019) mmHg·s·cm, ICC: 0.90 for DCI; 7.4 (0.8) vs. 6.9 (0.9) s, ICC: 0.50 for DL; and 8.1 (4.8) vs. 7.9 (5.1), ICC: 0.39 for IRP 4s. The normal values for this water-perfused HRM system are only slightly different from previously published values with solid-state HRM, and moderate to good agreement was observed between the two systems, with only small differences in outcome measures.
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Clinical Applications of Esophageal Impedance Monitoring and High-Resolution Manometry
Current Gastroenterology Reports, 2012Co-Authors: Boudewijn F. Kessing, Andre J P M Smout, Albert J BredenoordAbstract:Esophageal impedance monitoring and High-Resolution Manometry (HRM) are useful tools in the diagnostic work-up of patients with upper gastrointestinal complaints. Impedance monitoring increases the diagnostic yield for gastroesophageal reflux disease in adults and children and has become the gold standard in the diagnostic work-up of reflux symptoms. Its role in the work-up for belching disorders and rumination seems promising. HRM is superior to other diagnostic tools for the evaluation of achalasia and contributes to a more specific classification of esophageal disorders in patients with non-obstructive dysphagia. The role of HRM in patients with dysphagia after laparoscopic placement of an adjustable gastric band seems promising. Future studies will further determine the clinical implications of the new insights which have been acquired with these techniques. This review aims to describe the clinical applications of impedance monitoring and HRM.
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technical aspects of clinical High Resolution Manometry studies
Neurogastroenterology and Motility, 2012Co-Authors: Albert J Bredenoord, Geoffrey S HebbardAbstract:Background A number of commercial and research systems are available for making High-Resolution Manometry recordings. Purpose In this document, we review the standard equipment, patient preparation and routine protocol for High-Resolution Manometry. The major differences between HRM systems lie in the method of signal transduction, with solid-state catheter systems recording form intraluminal transducers and water perfusion systems recording pressures from external transducers via a perfused silicone catheter. The variations in recording systems result in different mechanical and electrical characteristics which dictate different techniques for setting up and using equipment. These issues are relevant in terms of costs and day to day management, but have little clinical significance. After the equipment is prepared for a manometric study, the esophagus is intubated transnasally with the manometric catheter and the catheter is positioned so that the UES and LES/diaphragm are visualized on the recording screen. The subject then undergoes 10 5ml water swallows in the supine position. Manometric data may be integrated with other data streams such as multichannel impedance or images from fluoroscopy to increase the power of the technique in difficult cases.
Sabine Roman - One of the best experts on this subject based on the ideXlab platform.
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esophageal motility disorders on High Resolution Manometry chicago classification version 4 0
Neurogastroenterology and Motility, 2021Co-Authors: Rena Yadlapati, Peter J. Kahrilas, Albert J Bredenoord, Sabine Roman, Prakash C Gyawali, Mark A Fox, Arash Babaei, Ravinder K MittalAbstract:Chicago Classification v4.0 (CCv4.0) is the updated classification scheme for esophageal motility disorders using metrics from High-Resolution Manometry (HRM). Fifty-two diverse international experts separated into seven working subgroups utilized formal validated methodologies over two-years to develop CCv4.0. Key updates in CCv.4.0 consist of a more rigorous and expansive HRM protocol that incorporates supine and upright test positions as well as provocative testing, a refined definition of esophagogastric junction (EGJ) outflow obstruction (EGJOO), more stringent diagnostic criteria for ineffective esophageal motility and description of baseline EGJ metrics. Further, the CCv4.0 sought to define motility disorder diagnoses as conclusive and inconclusive based on associated symptoms, and findings on provocative testing as well as supportive testing with barium esophagram with tablet and/or functional lumen imaging probe. These changes attempt to minimize ambiguity in prior iterations of Chicago Classification and provide more standardized and rigorous criteria for patterns of disorders of peristalsis and obstruction at the EGJ.
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esophageal provocation tests are they useful to improve diagnostic yield of High Resolution Manometry
Neurogastroenterology and Motility, 2018Co-Authors: Dustin A. Carlson, Sabine RomanAbstract:High Resolution Manometry (HRM) is the gold standard to diagnose esophageal motility disorders but has some limitations. The inclusion of provocative tests might enhance the diagnostic yield of HRM. These tests are easy to perform and to add to the regular Manometry protocol. Multiple rapid swallows (MRS; 5 2-mL swallows) is useful to assess the contractile reserve and deglutitive inhibition. The optimal number of MRS to perform might be 3 as suggested by Mauro et al. in this issue of Neurogastroenterology & Motility. The absence of contractile reserve might be associated with gastro-esophageal reflux disease and with an increased risk of post fundoplication dysphagia. Single viscous and solid swallows might enhance the detection of esophageal motility disorders but are not significantly associated with symptom occurrence. Test meal has the advantage to represent a real-life scenario and is promising to depict significant motility findings responsible for esophageal symptoms. Post-prandial recording might also be of interest to diagnose rumination and belching disorders. The best indication of rapid drink challenge test (free drinking of 200 mL) is currently the diagnosis of esophago-gastric junction obstruction. Finally, abdominal compression might be an option to evaluate response of esophageal peristalsis in a context of outflow resistance as proposed by Brink et al. in this issue. These provocative maneuvers appear to provide a complementary role in the evaluation of esophageal motility but require prospective studies to determine the validity of the findings and whether they will lead to changes in clinical practice.
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High Resolution Manometry improves the diagnosis of esophageal motility disorders in patients with dysphagia a randomized multicenter study
The American Journal of Gastroenterology, 2016Co-Authors: Sabine Roman, Laure Huot, Frank Zerbib, Stanislas Bruley Des Varannes, Guillaume Gourcerol, Benoit Coffin, A Ropert, Adeline Roux, Francois MionAbstract:High-Resolution Manometry Improves the Diagnosis of Esophageal Motility Disorders in Patients With Dysphagia: A Randomized Multicenter Study
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normative values in esophageal High Resolution Manometry
Neurogastroenterology and Motility, 2015Co-Authors: T V K Herregods, Peter J. Kahrilas, Sabine Roman, Andre J P M Smout, A J BredenoordAbstract:Background Esophageal High-Resolution Manometry (HRM) has rapidly gained much popularity worldwide. The Chicago Classification for esophageal motility disorders is based on a set of normative values for key metrics that was obtained using one of the commercially available HRM systems. Thus, it is of great importance to evaluate whether these normative values can be used for other HRM systems as well. Purpose In this review, we describe the presently available HRM systems, the currently known normative thresholds and the factors that influence them, and assess the use of these thresholds. Numerous factors including the type of HRM system, demographic factors, catheter diameter, body position during testing, consistency of bolus swallows, and esophageal length have an influence on the normative data. It would thus be ideal to have different sets of normal values for each of these factors, yet at the moment the amount of normative data is limited. We suggest broadening the normal range for parameters, as this would allow abnormal values to be of more significance. In addition, we suggest conducting studies to assess the physiological relevance of abnormal values and stress that for each system different normative thresholds may apply.
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High Resolution Manometry correlates of ineffective esophageal motility
The American Journal of Gastroenterology, 2012Co-Authors: Yinglian Xiao, Peter J. Kahrilas, Mary J Kwasny, Sabine Roman, Zhiyue Lin, Frederic Nicodeme, John E. PandolfinoAbstract:Background There are currently no criteria for ineffective esophageal motility (IEM) and ineffective swallow (IES) in High Resolution Manometry (HRM) and Esophageal Pressure Topography (EPT). Our aims were to utilize HRM metrics to define IEM within the Chicago Classification and to determine the distal contractile integral (DCI) threshold for IES.
A J Bredenoord - One of the best experts on this subject based on the ideXlab platform.
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Validation of criteria for the definition of transient lower esophageal sphincter relaxations using High-Resolution Manometry
'Wiley', 2017Co-Authors: S. Roman, A J Bredenoord, Bruley Des S Varannes, R. Holloway, J. Keller, F. Herbella, F. Zerbib, Y. Xiao, L. Bernard, M. ChenAbstract:Background: Criteria for transient lower esophageal sphincter relaxations (TLESRs) are well-defined for Dentsleeve Manometry. As High-Resolution Manometry (HRM) is now the gold standard to assess esophageal motility, our aim was to propose a consensus definition of TLESRs using HRM. Methods: Postprandial esophageal HRM combined with impedance was performed in 10 patients with gastroesophageal reflux disease. Transient lower esophageal sphincter relaxations identification was performed by 17 experts using a Delphi process. Four investigators then characterized TLESR candidates that achieved 100% agreement (TLESR events) and those that achieved less than 25% agreement (non-events) after the third round. Logistic regression and decision tree analysis were used to define optimal diagnostic criteria. Key Results: All diagnostic criteria were more frequently encountered in the 57 TLESR events than in the 52 non-events. Crural diaphragm (CD) inhibition and LES relaxation duration >10 seconds had the Highest predictive value to identify TLESR. Based on decision tree analysis, reflux on impedance, esophageal shortening, common cavity, upper esophageal sphincter relaxation without swallow and secondary peristalsis were alternate diagnostic criteria. Conclusion & Inferences: Using HRM, TLESR might be defined as LES relaxation occurring in absence of swallowing, lasting more than 10 seconds and associated with CD inhibition
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normative values in esophageal High Resolution Manometry
Neurogastroenterology and Motility, 2015Co-Authors: T V K Herregods, Peter J. Kahrilas, Sabine Roman, Andre J P M Smout, A J BredenoordAbstract:Background Esophageal High-Resolution Manometry (HRM) has rapidly gained much popularity worldwide. The Chicago Classification for esophageal motility disorders is based on a set of normative values for key metrics that was obtained using one of the commercially available HRM systems. Thus, it is of great importance to evaluate whether these normative values can be used for other HRM systems as well. Purpose In this review, we describe the presently available HRM systems, the currently known normative thresholds and the factors that influence them, and assess the use of these thresholds. Numerous factors including the type of HRM system, demographic factors, catheter diameter, body position during testing, consistency of bolus swallows, and esophageal length have an influence on the normative data. It would thus be ideal to have different sets of normal values for each of these factors, yet at the moment the amount of normative data is limited. We suggest broadening the normal range for parameters, as this would allow abnormal values to be of more significance. In addition, we suggest conducting studies to assess the physiological relevance of abnormal values and stress that for each system different normative thresholds may apply.
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accuracy of hiatal hernia detection with esophageal High Resolution Manometry
Neurogastroenterology and Motility, 2015Co-Authors: Pim W Weijenborg, A J P M Smout, F B Van Hoeij, A J BredenoordAbstract:Background The diagnosis of a sliding hiatal hernia is classically made with endoscopy or barium esophagogram. Spatial separation of the lower esophageal sphincter (LES) and diaphragm, the hallmark of hiatal hernia, can also be observed on High-Resolution Manometry (HRM), but the diagnostic accuracy of this finding has not yet been investigated. To determine the diagnostic value of HRM in the detection of hiatal hernia. Methods HRM recordings, endoscopy reports, and barium esophagograms of 90 patients were analyzed for the presence and size of a hiatal hernia. The diagnostic value of a hernia specific HRM pressure pattern was calculated, and the agreement of HRM with endoscopy and barium esophagogram for the assessment of hernia size. Key Results HRM was found to be Highly sensitive and specific for hiatal hernia detection, with a sensitivity of 92% and specificity of 95%, exceeding the sensitivity of endoscopy or radiography alone (both 73%). Patients with a hiatal hernia on HRM were manometrically characterized by an esophagogastric junction (EGJ) with partial or complete separation of the LES and crural diaphragm (CD), the latter being associated with significantly lower EGJ pressure. A cutoff value of spatial LES-CD separation on HRM of 1.85 cm yielded the optimal performance in identifying hiatal hernia. Agreement between HRM, endoscopy, and radiography for size of hiatal hernias was good (ICC [95% CI] 0.74 [0.65–0.82]). Conclusions & Inferences With HRM, the presence or absence and size of a hiatal hernia can be assessed with greater sensitivity than with endoscopy or radiography alone.
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normal values for esophageal High Resolution Manometry
Neurogastroenterology and Motility, 2013Co-Authors: Auke Bogte, A J Bredenoord, J Oors, Peter D Siersema, Andre J P M SmoutAbstract:Background Esophageal High-Resolution Manometry (HRM) is a novel method to assess esophageal motility. Several software and hardware systems are currently available. A set of normal values for HRM parameters was established in the US, using proprietary tactile-sensing catheter technology (Given Imaging). We wished to determine normal values for HRM performed with another type of catheter (Unisensor). Methods Fifty-two healthy volunteers underwent supine HRM. Each subject swallowed 10 liquid water boluses. Esophageal contraction parameters were evaluated and normal values were calculated (defined as 5th and 95th percentile of values). Key Results The normal range for the following parameters was calculated; distal contractile integral (mean 1319.44, with a 5-95th percentile range [185.65-3407.60]), contractile front velocity (mean 3.98, 5-95th percentile range [2.40-6.50]), Intrabolus pressure (mean 9.68, range [1.00-19.00]), contraction amplitude measured 5 cm above the esophagogastric junction (EGJ; mean 78.76, range [23.00-146.00]), contraction amplitude 15 cm above the EGJ (mean 43.66, range [3.60-96.00]), transition zone (TZ) length (mean 1.34, range [0.00-5.63]), upper esophageal sphincter (UES) pressure (mean 81.63, range [19.50-165.10]), EGJ length (mean 2.97, range [2.17-4.00]), EGJ resting pressure (mean 29.35, range [8.95-51.40]), EGJ relaxation pressure (mean 16.79, range [1.00-39.35]), IRPs4 (mean 13.42, range [2.59-28.28]), and gastric pressure (mean 5.06, range [0.00-9.46]). Conclusions & Inferences Overall, the normal values of esophageal HRM parameters obtained with the Unisensor catheter resemble those of the previously published series. Marked differences in upper limits of normal were found for parameters related to the esophageal sphincters and TZ length. Users of HRM should be aware of these differences and define pathology based on comparison to appropriate normal values.
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mechanisms of gastric and supragastric belching a study using concurrent High Resolution Manometry and impedance monitoring
Neurogastroenterology and Motility, 2012Co-Authors: Boudewijn F. Kessing, A J Bredenoord, A J P M SmoutAbstract:Background Esophageal impedance monitoring has made it possible to distinguish two types of belches, designated gastric and supragastric. We aimed to compare the esophageal pressure characteristics during supragastric belches and gastric belches using combined High-Resolution Manometry and impedance monitoring. Methods We included 10 patients with severe and frequent belching. Combined High-Resolution Manometry and impedance monitoring was performed. Key Results Whereas gastric belching was relatively rare in all patients (median incidence 2 per 90-min period), nine of the 10 patients exhibited excessive supragastric belching (36 in 90 min). Supragastric belches were characterized by: (i) movement of the diaphragm in aboral direction and increased esophagogastric junction (EGJ) pressure, (ii) decrease in esophageal pressure, (iii) upper esophageal sphincter (UES) relaxation, (iv) antegrade airflow into the esophagus, and (v) increase in esophageal and gastric pressure leading to expulsion of air out of the esophagus in retrograde direction. In contrast, gastric belches were characterized by: (i) decreased or unchanged EGJ pressure, which was significantly lower than during supragastric belches, (ii) absence of decreased esophageal pressure preceding entrance of air into the esophagus (iii) retrograde airflow into the esophagus, (iv) common cavity phenomenon, and (v) upper esophageal sphincter relaxation after the onset of the retrograde airflow. Conclusions & Inferences In gastric belching UES relaxation is a late event, allowing efflux of air that entered the esophagus from the stomach. In most patients with supragastric belching air is brought into the esophagus by movement of the diaphragm in aboral direction, creation of negative esophageal pressure, and UES relaxation.