| Detection of incomplete lower esophageal sphincter relaxation with conventional point-pressure sensors. | |
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MedLine Citation:
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PMID: 11774934 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Completeness of lower esophageal sphincter relaxation, a parameter used to establish the diagnosis of achalasia, is an important manometric determination. This study compared four analysis methods that use point-pressure measurements to determine their relative accuracy and the best threshold values for incomplete relaxation. METHODS: Analyses were performed on 153 manometric studies that employed a 21-lumen catheter with pressure recording sites spaced at 1-cm intervals. Lower sphincter relaxation was measured from most appropriate sites as the 1) lowest residual pressure within 5 s of swallowing, 2) lowest residual pressure across the entire postdeglutitive period, 3) lowest mean residual pressure over a floating 3-s interval after swallowing, and 4) mean transsphincteric esophagogastric gradient extracted from a combination of conventional and topographic manometric information. Intragastric baseline pressures were taken both from the pull-through maneuver and from concurrent intragastric recordings, and methods were compared by their receiver operating characteristics. RESULTS: Best threshold values for segregating achalasia from nonachalasic controls differed across methods and depended on presence or absence of peristalsis in the comparison group. Transsphincteric gradient measurement had high sensitivity (> or = 0.94) and specificity (> or = 0.98) for achalasia irrespective of comparison group and was superior to all other methods. The 3-s mean residual pressure demonstrated greatest discriminant capabilities of the remaining conventional methods, which were modestly improved with concurrent measurement of intragastric pressure. CONCLUSIONS: Analyses that average postdeglutitive pressures are superior to isolated nadir values in correctly discerning incomplete lower sphincter relaxation. The transsphincteric gradient is a novel approach for measuring sphincter relaxation, is unaffected by sphincter asymmetry and axial movement, and has the best receiver operating characteristics using point-pressure sensors. |
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Authors:
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A Staiano; R E Clouse |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: The American journal of gastroenterology Volume: 96 ISSN: 0002-9270 ISO Abbreviation: Am. J. Gastroenterol. Publication Date: 2001 Dec |
Date Detail:
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Created Date: 2001-12-31 Completed Date: 2002-01-16 Revised Date: 2006-11-15 |
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: 3258-67 Citation Subset: IM |
Affiliation:
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Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri 63110, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Differential Threshold Esophageal Achalasia / diagnosis* Esophagogastric Junction / physiopathology* Female Humans Male Manometry / methods* Middle Aged Muscle Relaxation / physiology* Postprandial Period Pressure |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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