| Classifying esophageal motility by pressure topography characteristics: a study of 400 patients and 75 controls. | |
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MedLine Citation:
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PMID: 17900331 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIM: This study aimed to devise a scheme for the systematic analysis of esophageal high-resolution manometry (HRM) studies displayed using topographic plotting. METHODS: A total of 400 patients and 75 control subjects were studied with a 36-channel HRM assembly. Studies were analyzed in a stepwise fashion for: (a) the adequacy of deglutitive esophagogastric junction (EGJ) relaxation, (b) the presence and propagation characteristics of distal esophageal persitalsis, and (c) an integral of the magnitude and span of the distal esophageal contraction. RESULTS: Two strengths of pressure topography plots compared to conventional manometric recordings were: (a) the ability to delineate the spatial limits, vigor, and integrity of individual contractile segments along the esophagus, and (b) the ability to distinguish between loci of compartmentalized intraesophageal pressurization and rapidly propagated contractions. Making these distinctions objectified the identification of distal esophageal spasm (DES), vigorous achalasia, functional obstruction, and nutcracker esophagus subtypes. Applying these distinctions made the diagnosis of spastic disorders quite rare: (a) DES in 1.5% patients, (b) vigorous achalasia in 1.5%, and (c) a newly defined entity, spastic nutcracker, in 1.5%. CONCLUSIONS: We developed a systematic approach to analyzing esophageal motility using HRM and pressure topography plots. The resultant scheme is consistent with conventional classifications with the caveats that: (a) hypercontractile conditions are more specifically defined, (b) distinctions are made between rapidly propagated contractions and compartmentalized esophageal pressurization, and (c) there is no "nonspecific esophageal motor disorder" classification. We expect that pressure topography analysis, with its well-defined functional implications, will prove valuable in the clinical management of esophageal motility disorders. |
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Authors:
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John E Pandolfino; Sudip K Ghosh; John Rice; John O Clarke; Monika A Kwiatek; Peter J Kahrilas |
Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, N.I.H., Extramural Date: 2007-09-26 |
Journal Detail:
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Title: The American journal of gastroenterology Volume: 103 ISSN: 0002-9270 ISO Abbreviation: Am. J. Gastroenterol. Publication Date: 2008 Jan |
Date Detail:
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Created Date: 2008-01-10 Completed Date: 2008-03-13 Revised Date: 2008-10-28 |
Medline Journal Info:
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Nlm Unique ID: 0421030 Medline TA: Am J Gastroenterol Country: United States |
Other Details:
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Languages: eng Pagination: 27-37 Citation Subset: IM |
Affiliation:
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Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Esophageal Diseases / classification*, physiopathology Esophagus / physiopathology* Female Gastrointestinal Motility / physiology* Humans Image Processing, Computer-Assisted / methods* Male Manometry / methods Middle Aged Pressure Reproducibility of Results Severity of Illness Index |
| Grant Support | |
ID/Acronym/Agency:
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K23 DK062170-01/DK/NIDDK NIH HHS; R01 DC00646/DC/NIDCD NIH HHS |
| Comments/Corrections | |
Comment In:
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Am J Gastroenterol. 2008 Oct;103(10):2657-8
[PMID:
18855865
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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