1
|
Gulinac M, Kiprin G, Tsranchev I, Graklanov V, Chervenkov L, Velikova T. Clinical issues and challenges in imaging of gastrointestinal diseases: A minireview and our experience. World J Clin Cases 2024; 12:3304-3313. [DOI: 10.12998/wjcc.v12.i18.3304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/25/2024] [Accepted: 05/06/2024] [Indexed: 06/13/2024] Open
Abstract
Imaging techniques play a crucial role in the modern era of medicine, particularly in gastroenterology. Nowadays, various non-invasive and invasive imaging modalities are being routinely employed to evaluate different gastrointestinal (GI) diseases. However, many instrumental as well as clinical issues are arising in the area of modern GI imaging. This minireview article aims to briefly overview the clinical issues and challenges encountered in imaging GI diseases while highlighting our experience in the field. We also summarize the advances in clinically available diagnostic methods for evaluating different diseases of the GI tract and demonstrate our experience in the area. In conclusion, almost all imaging techniques used in imaging GI diseases can also raise many challenges that necessitate careful consideration and profound expertise in this field.
Collapse
Affiliation(s)
- Milena Gulinac
- Department of General and Clinical Pathology, Medical University of Plovdiv, Plovdiv 4002, Bulgaria
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
| | - Georgi Kiprin
- Department of Gastroenterology, MHAT Eurohospital, Plovdiv 4000, Bulgaria
| | - Ivan Tsranchev
- Department of Forensic Medicine and Deontology, Medical University of Plovdiv, Plovdiv 4000, Bulgaria
| | - Vasko Graklanov
- First Department of Internal Diseases, Medical University of Plovdiv, Plovdiv 4000, Bulgaria
| | - Lyubomir Chervenkov
- Department of Diagnostic Imaging, Medical University Plovdiv, Plovdiv 4000, Bulgaria
| | - Tsvetelina Velikova
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
| |
Collapse
|
2
|
Pomenti S, Nathanson J, Phipps M, Aneke-Nash C, Katzka D, Freedberg D, Jodorkovsky D. Esophagogastroduodenoscopy findings that do no not explain dysphagia are associated with underutilization of high-resolution manometry. Dis Esophagus 2024:doae028. [PMID: 38582609 DOI: 10.1093/dote/doae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 04/08/2024]
Abstract
In patients with dysphagia that is not explained by upper endoscopy, high-resolution esophageal manometry (HRM) is the next logical step in diagnostic testing. This study investigated predictors of failure to refer for HRM after an upper endoscopy that was performed for but did not explain dysphagia. This was a retrospective cohort study of patients >18 years of age who underwent esophagogastroduodenoscopy (EGD) for dysphagia from 2015 to 2021. Patients with EGD findings that explained dysphagia (e.g. esophageal mass, eosinophilic esophagitis, Schatzki ring, etc.) were excluded from the main analyses. The primary outcome was failure to refer for HRM within 1 year of the index non-diagnostic EGD. We also investigated delayed referral for HRM, defined as HRM performed after the median. Multivariable logistic regression modeling was used to identify risk factors that independently predicted failure to refer for HRM, conditioned on the providing endoscopist. Among 2132 patients who underwent EGD for dysphagia, 1240 (58.2%) did not have findings to explain dysphagia on the index EGD. Of these 1240 patients, 148 (11.9%) underwent HRM within 1 year of index EGD. Endoscopic findings (e.g. hiatal hernia, tortuous esophagus, Barrett's esophagus, surgically altered anatomy not involving the gastroesophageal junction, and esophageal varices) perceived to explain dysphagia were independently associated with failure to refer for HRM (adjusted odds ratio 0.45, 95% confidence interval 0.25-0.80). Of the 148 patients who underwent HRM within 1 year of index EGD, 29.7% were diagnosed with a disorder of esophagogastric junction outflow, 17.6% with a disorder of peristalsis, and 2.0% with both disorders of esophagogastric outflow and peristalsis. The diagnosis made by HRM was similar among those who had incidental EGD findings that were non-diagnostic for dysphagia compared with those who had completely normal EGD findings. Demographic factors including race/ethnicity, insurance type, and income were not associated with failure to refer for HRM or delayed HRM. Patients with dysphagia and endoscopic findings unrelated to dysphagia have a similar prevalence of esophageal motility disorders to those with normal endoscopic examinations, yet these patients are less likely to undergo HRM. Provider education is indicated to increase HRM referral in these patients.
Collapse
Affiliation(s)
- Sydney Pomenti
- Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA
| | - John Nathanson
- Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA
| | - Meaghan Phipps
- Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA
| | - Chino Aneke-Nash
- Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA
| | - David Katzka
- Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA
| | - Daniel Freedberg
- Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA
| | - Daniela Jodorkovsky
- Department of Medicine, Division of Digestive Diseases, Mount Sinai Doctors, New York, NY, USA
| |
Collapse
|
3
|
Dorfman L, Jahagirdar V, Kaul S, El-Chammas K, Kaul A. Comprehensive Manometric Evaluation of Dysphagia in Patients with Down Syndrome. Dysphagia 2023; 38:1589-1597. [PMID: 37171663 DOI: 10.1007/s00455-023-10586-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/26/2023] [Indexed: 05/13/2023]
Abstract
Dysphagia is a common symptom in children with Down syndrome and is conventionally evaluated with imaging and endoscopy; high-resolution manometry is not routinely utilized. The aim of this study was to describe and correlate pharyngeal and esophageal manometry findings with contrast studies and endoscopy in patients with Down syndrome and dysphagia. Electronic medical records of patients with Down syndrome with dysphagia seen at our center between January 2008 and January 2022 were reviewed. Data collected included demographics, co-morbidities, symptoms, imaging, endoscopy, and manometry. Twenty-four patients with Down syndrome [median age of 14.9 years (IQR 7.6, 20.5), 20.8% female] met inclusion criteria. Common presenting symptoms of dysphagia included vomiting or regurgitation in 15 (62.5%) patients, and choking, gagging, or retching in 10 (41.7%) patients. Esophageal manometry was abnormal in 18/22 (81.2%) patients. The most common findings were ineffective esophageal motility in 9 (40.9%) followed by esophageal aperistalsis in 8 (36.4%) patients. Rumination pattern was noted in 5 (22.8%) patients. All 6 (25%) patients who previously had fundoplication had esophageal dysmotility. Strong agreement was noted between upper gastrointestinal studies and high-resolution esophageal manometry (p = 1.0) but no agreement was found between pharyngeal manometry and video fluoroscopic swallow studies (p = 0.041). High-resolution pharyngeal and esophageal manometry provide complementary objective data that may be critical in tailoring therapeutic strategies for managing patients with Down syndrome with dysphagia.
Collapse
Affiliation(s)
- Lev Dorfman
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue Cincinnati, Cincinnati, OH, 45229, USA.
| | - Vinay Jahagirdar
- Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Serena Kaul
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue Cincinnati, Cincinnati, OH, 45229, USA
| | - Khalil El-Chammas
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue Cincinnati, Cincinnati, OH, 45229, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ajay Kaul
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue Cincinnati, Cincinnati, OH, 45229, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
4
|
El Halabi M, Arwani R, Parkman HP. Dysphagia in Neurological Disorders. Semin Neurol 2023; 43:530-539. [PMID: 37579785 DOI: 10.1055/s-0043-1771458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
Dysphagia is a common symptom in many neurologic disorders. Patients with oropharyngeal dysphagia present with difficulties when they start to swallow, often with coughing and choking; whereas patients with esophageal dysphagia describe the feeling that swallowed food stops in the chest. Chronic neurologic diseases such stroke, Parkinson's disease, or dementia often have dysphagia as a symptom, particularly oropharyngeal dysphagia, and the term "neurogenic dysphagia" is often used. A disruption of the sophisticated, integrated sensorimotor swallowing system is usually the main reason behind dysphagia. Dysphagia can be associated with aspiration leading to aspiration pneumonia, and chronic dysphagia can lead to weight loss and malnutrition. Patients with dysphagia, when accurately and promptly diagnosed through medical history, physical examination, and diagnostic tests, often can be treated and experience improved quality of life. The pathophysiological mechanisms behind dysphagia, its diagnosis, and potential treatments are discussed in this manuscript.
Collapse
Affiliation(s)
- Maan El Halabi
- Section of Gastroenterology, Temple University Hospital, Philadelphia, Pennsylvania
| | - Remy Arwani
- Department of Internal Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Henry P Parkman
- GI Motility Laboratory, Section of Gastroenterology, Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| |
Collapse
|
5
|
Li MY, Wang QH, Chen RP, Su XF, Wang DY. Pathogenesis, clinical manifestations, diagnosis, and treatment progress of achalasia of cardia. World J Clin Cases 2023; 11:1741-1752. [PMID: 36970002 PMCID: PMC10037292 DOI: 10.12998/wjcc.v11.i8.1741] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/06/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023] Open
Abstract
Achalasia cardia, type of esophageal dynamic disorder, is a relatively rare primary motor esophageal disease characterized by the functional loss of plexus ganglion cells in the distal esophagus and lower esophageal sphincter. Loss of function of the distal and lower esophageal sphincter ganglion cells is the main cause of achalasia cardia, and is more likely to occur in the elderly. Histological changes in the esophageal mucosa are considered pathogenic; however, studies have found that inflammation and genetic changes at the molecular level may also cause achalasia cardia, resulting in dysphagia, reflux, aspiration, retrosternal pain, and weight loss. Currently, the treatment options for achalasia focus on reducing the resting pressure of the lower esophageal sphincter, helping to empty the esophagus and relieve symptoms. Treatment measures include botulinum toxin injection, inflatable dilation, stent insertion, and surgical myotomy (open or laparoscopic). Surgical procedures are often subject to controversy owing to concerns about safety and effectiveness, particularly in older patients. Herein, we review clinical epidemiological and experimental data to determine the prevalence, pathogenesis, clinical presentation, diagnostic criteria, and treatment options for achalasia to support its clinical management.
Collapse
Affiliation(s)
- Ming-Yue Li
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
| | - Qing-Hua Wang
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
| | - Run-Peng Chen
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
| | - Xiao-Fang Su
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
| | - Dong-Yang Wang
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
- Faculty of Nursing, Mahidol University, Nakhon Pathom 73170, Thailand
| |
Collapse
|