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How the Body Position Can Influence High-resolution Manometry Results in the Study of Esophageal Dysphagia and Gastroesophageal Reflux Disease.

Ciriza-de-Los-Ríos C, Canga-Rodríguez-Valcárcel F, Lora-Pablos D, De-La-Cruz-Bértolo J, Castel-de-Lucas I, Castellano-Tortajada G - J Neurogastroenterol Motil (2015)

Bottom Line: HRM plots were analyzed according to the Chicago classification.HRM results varied in the final diagnoses of the esophageal body (EB) in patients with dysphagia (P = 0.024), the result being more distal spasm and weak peristalsis while sitting.Hypotensive LES, EGJ type III (hiatal hernia), and weak peristalsis were more frequently identified in the sitting position.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Hospital Universitario 12 de Octubre, Madrid, Spain.

ABSTRACT

Background/aims: The body position can influence esophageal motility data obtained with high-resolution manometry (HRM). To examine whether the body position influences HRM diagnoses in patients with esophageal dysphagia and gastroesophageal reflux disease (GERD).

Methods: HRM (Manoscan) was performed in 99 patients in the sitting and supine positions; 49 had dysphagia and 50 had GERD as-sessed by 24-hour pH monitoring. HRM plots were analyzed according to the Chicago classification.

Results: HRM results varied in the final diagnoses of the esophageal body (EB) in patients with dysphagia (P = 0.024), the result being more distal spasm and weak peristalsis while sitting. In patients with GERD, the HRM diagnoses of the lower esophageal sphinc-ter (LES), the esophagogastric junction (EGJ) morphology, and EB varied depending on the position; (P = 0.063, P = 0.017, P = 0.041 respectively). Hypotensive LES, EGJ type III (hiatal hernia), and weak peristalsis were more frequently identified in the sitting position. The reliability (kappa) of the position influencing HRM diagnoses was similar in dysphagia and GERD ("LES diagnosis": dysphagia 0.32 [0.14-0.49] and GERD 0.31 [0.10-0.52], P = 0.960; "EB diagnosis": dysphagia 0.49 [0.30-0.69] and GERD 0.39 [0.20-0.59], P = 0.480). The reliability in "EGJ morphology" studies was higher in dysphagia 0.81 (0.68-0.94) than in GERD 0.55 (0.37-0.73), P = 0.020.

Conclusions: HRM results varied according to the position in patients with dysphagia and GERD. Weak peristalsis was more frequently diagnosed while sitting in dysphagia and GERD. Hypotensive LES and EGJ type III (hiatal hernia) were also more frequently diagnosed in the sitting position in patients with GERD.

No MeSH data available.


Related in: MedlinePlus

Manometric changes according to the body position in patients with gastroesophageal reflux disease (GERD). (A) Change in lower esophageal sphincter (LES) diagnosis in patients with GERD according to the body position. (B) Change in esophagogastric junction (EGJ) morphology in patients with GERD according to the body position. (C) Change in esophageal body diagnosis in patients with GERD according to the body position. P, peristalsis.
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f3-jnm-21-370: Manometric changes according to the body position in patients with gastroesophageal reflux disease (GERD). (A) Change in lower esophageal sphincter (LES) diagnosis in patients with GERD according to the body position. (B) Change in esophagogastric junction (EGJ) morphology in patients with GERD according to the body position. (C) Change in esophageal body diagnosis in patients with GERD according to the body position. P, peristalsis.

Mentions: Patients with GERD had different HRM diagnoses for LES, EGJ morphology, and EB depending on the body position (P = 0.063, P = 0.017, P = 0.041, respectively; Fig. 3). More hypotensive LES and EGJ type III (hiatal hernia) were identified in the sitting position (Fig. 3A and 3B). Weak peristalsis was also diagnosed more frequently in the sitting position (Fig. 3C) and was the most prominent for EB in patients with dysphagia and GERD. Weak contractions were subanalyzed in the 2 body positions. Changing from sitting to supine 46.3% of the deglutitions normalized the integrity in the 20 mmHg isobaric contour. In the sitting position, 205 of 990 total deglutitions had weak peristalsis. One hundred and thirty-six of them failed in 50 large and 19 small breaks in the 20 mmHg isobaric contour, respectively. In supine, 110 of 990 total deglutitions had weak peristalsis, of which 58 failed in 23 having large and 29 small breaks (Fig. 4).


How the Body Position Can Influence High-resolution Manometry Results in the Study of Esophageal Dysphagia and Gastroesophageal Reflux Disease.

Ciriza-de-Los-Ríos C, Canga-Rodríguez-Valcárcel F, Lora-Pablos D, De-La-Cruz-Bértolo J, Castel-de-Lucas I, Castellano-Tortajada G - J Neurogastroenterol Motil (2015)

Manometric changes according to the body position in patients with gastroesophageal reflux disease (GERD). (A) Change in lower esophageal sphincter (LES) diagnosis in patients with GERD according to the body position. (B) Change in esophagogastric junction (EGJ) morphology in patients with GERD according to the body position. (C) Change in esophageal body diagnosis in patients with GERD according to the body position. P, peristalsis.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496909&req=5

f3-jnm-21-370: Manometric changes according to the body position in patients with gastroesophageal reflux disease (GERD). (A) Change in lower esophageal sphincter (LES) diagnosis in patients with GERD according to the body position. (B) Change in esophagogastric junction (EGJ) morphology in patients with GERD according to the body position. (C) Change in esophageal body diagnosis in patients with GERD according to the body position. P, peristalsis.
Mentions: Patients with GERD had different HRM diagnoses for LES, EGJ morphology, and EB depending on the body position (P = 0.063, P = 0.017, P = 0.041, respectively; Fig. 3). More hypotensive LES and EGJ type III (hiatal hernia) were identified in the sitting position (Fig. 3A and 3B). Weak peristalsis was also diagnosed more frequently in the sitting position (Fig. 3C) and was the most prominent for EB in patients with dysphagia and GERD. Weak contractions were subanalyzed in the 2 body positions. Changing from sitting to supine 46.3% of the deglutitions normalized the integrity in the 20 mmHg isobaric contour. In the sitting position, 205 of 990 total deglutitions had weak peristalsis. One hundred and thirty-six of them failed in 50 large and 19 small breaks in the 20 mmHg isobaric contour, respectively. In supine, 110 of 990 total deglutitions had weak peristalsis, of which 58 failed in 23 having large and 29 small breaks (Fig. 4).

Bottom Line: HRM plots were analyzed according to the Chicago classification.HRM results varied in the final diagnoses of the esophageal body (EB) in patients with dysphagia (P = 0.024), the result being more distal spasm and weak peristalsis while sitting.Hypotensive LES, EGJ type III (hiatal hernia), and weak peristalsis were more frequently identified in the sitting position.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Hospital Universitario 12 de Octubre, Madrid, Spain.

ABSTRACT

Background/aims: The body position can influence esophageal motility data obtained with high-resolution manometry (HRM). To examine whether the body position influences HRM diagnoses in patients with esophageal dysphagia and gastroesophageal reflux disease (GERD).

Methods: HRM (Manoscan) was performed in 99 patients in the sitting and supine positions; 49 had dysphagia and 50 had GERD as-sessed by 24-hour pH monitoring. HRM plots were analyzed according to the Chicago classification.

Results: HRM results varied in the final diagnoses of the esophageal body (EB) in patients with dysphagia (P = 0.024), the result being more distal spasm and weak peristalsis while sitting. In patients with GERD, the HRM diagnoses of the lower esophageal sphinc-ter (LES), the esophagogastric junction (EGJ) morphology, and EB varied depending on the position; (P = 0.063, P = 0.017, P = 0.041 respectively). Hypotensive LES, EGJ type III (hiatal hernia), and weak peristalsis were more frequently identified in the sitting position. The reliability (kappa) of the position influencing HRM diagnoses was similar in dysphagia and GERD ("LES diagnosis": dysphagia 0.32 [0.14-0.49] and GERD 0.31 [0.10-0.52], P = 0.960; "EB diagnosis": dysphagia 0.49 [0.30-0.69] and GERD 0.39 [0.20-0.59], P = 0.480). The reliability in "EGJ morphology" studies was higher in dysphagia 0.81 (0.68-0.94) than in GERD 0.55 (0.37-0.73), P = 0.020.

Conclusions: HRM results varied according to the position in patients with dysphagia and GERD. Weak peristalsis was more frequently diagnosed while sitting in dysphagia and GERD. Hypotensive LES and EGJ type III (hiatal hernia) were also more frequently diagnosed in the sitting position in patients with GERD.

No MeSH data available.


Related in: MedlinePlus