1
|
Jia X, Chen S, Hou X, Zhuang Q, Tan N, Zhang M, Wang J, Xing X, Xiao Y. Development and Validation of Serum Markers as Noninvasive Diagnostic Methods for Achalasia. Clin Transl Gastroenterol 2024; 15:e00651. [PMID: 37787436 PMCID: PMC10810595 DOI: 10.14309/ctg.0000000000000651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023] Open
Abstract
INTRODUCTION Currently, the diagnosis of achalasia mainly relies on invasive or radioactive examinations. This study aimed to develop a noninvasive diagnostic method for achalasia based on specific serum markers. METHODS Serum levels of profilin-1, galectin-10, immunoglobulin heavy variable 3-9, vasodilator-stimulated phosphoprotein, and transgelin-2 were measured in patients with achalasia and controls by enzyme-linked immunosorbent assay. The diagnostic values and thresholds were determined by the receiver operating characteristic curve analysis. Then, patients with dysphagia were prospectively enrolled to validate the ability of these molecules for achalasia diagnosing. RESULTS A total of 142 patients with achalasia and 50 nonachalasia controls (healthy volunteers and patients with reflux esophagitis) were retrospectively included. The serum levels of profilin-1, galectin-10, and transgelin-2 in patients with achalasia were significantly higher than those in healthy volunteers and patients with reflux esophagitis ( P all < 0.001). Profilin-1, galectin-10, and transgelin-2 were of good performance in diagnosing achalasia, with optimal thresholds of 2,171.2, 33.9, and 1,630.6 pg/mL, respectively. Second, 40 patients with dysphagia were prospectively enrolled to the validation of achalasia. For profilin-1, the positive predictive value, negative predictive value, sensitivity, and specificity were 100.0%, 64.5%, 45.0%, and 100.0%, respectively. The figures for transgelin-2 were 65.5%, 90.9%, 95.0%, and 50.0%. When both increased, the positive predictive value reached to 100.0%. When both indexes were normal, the negative predictive value was 100.0%. DISCUSSION Profilin-1 and transgelin-2 were promising biomarkers for achalasia diagnosis and performed better in combination. Further multicenter studies are necessary to verify their application as preliminary screening tools for achalasia.
Collapse
Affiliation(s)
- Xingyu Jia
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, China
| | - Songfeng Chen
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, China
| | - Xun Hou
- Gastrointestinal Surgery Center, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, China
| | - Qianjun Zhuang
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, China
| | - Niandi Tan
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, China
| | - Mengyu Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, China
| | - Jinhui Wang
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, China
| | - Xiangbin Xing
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, China
| | - Yinglian Xiao
- Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangdong, China
| |
Collapse
|
2
|
Makamson LM, Holm TE, Jenkins HN, Mehaffey NA, Mansour EA, Coleman TP, Norton CH, Walker SC, McClain JE, Parker AC, Brousse BR, Schaefer DC, Kutcher ME, Moremen JR. Impedance Planimetry and the Changing Paradigm of Esophageal Dysphagia. Am Surg 2022; 88:1805-1808. [PMID: 35387505 DOI: 10.1177/00031348221084088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Patients presenting with dysphagia can encounter a pathway to therapy and relief that is expensive and frustrating. High resolution impedance planimetry (HRIP) is a new mechanism for enhancing and possibly hastening that process. A balloon with integrated pressure sensors is utilized to measure luminal geometry and pressure by volume-controlled distention. Esophagogastric junction (EGJ) distensibility and body contractility are assessed at the time of other endoscopic procedures. Here we describe a single-center experience utilizing HRIP in the endoscopic evaluation of patients presenting with dysphagia. METHODS A prospectively maintained registry of patients undergoing impedance planimetry assessments at an academic medical center was queried for demographics, procedural details, and patient-reported outcomes. RESULTS Data was reviewed for 122 procedures performed by two providers. HRIP was performed in 63 (52%) patients for initial dysphagia assessment, 36 (30%) for follow-up assessment, and 20 (16%) as a procedural adjunct at the time of other planned procedures. HRIP contractile response was characterized as normal in 36%, absent in 32%, and diminished/disorganized in 14%. These results motivated clinical planning for surgical referral in 7 (5%) patients, 31 (26%) additional testing, and 82 (68%) continued medical management and follow-up. DISCUSSION HRIP is an emerging endoscopic modality which can streamline diagnostic work-up and therapeutic planning for patients with symptomatic dysphagia. Using functional esophageal assessment at the time of other diagnostic and therapeutic procedures, HRIP may expedite care and lead to improved patient satisfaction and clinical outcomes.
Collapse
Affiliation(s)
- Luci M Makamson
- School of Medicine, 21693University of Mississippi Medical Center, Jackson, MS, USA
| | - Tyler E Holm
- School of Medicine, 21693University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Niall A Mehaffey
- School of Medicine, 21693University of Mississippi Medical Center, Jackson, MS, USA
| | - Emily A Mansour
- School of Medicine, 21693University of Mississippi Medical Center, Jackson, MS, USA
| | - Thomas P Coleman
- School of Medicine, 21693University of Mississippi Medical Center, Jackson, MS, USA
| | - Christian H Norton
- School of Medicine, 21693University of Mississippi Medical Center, Jackson, MS, USA
| | - Savannah C Walker
- Department of Surgery, 21693University of Mississippi Medical Center, Jackson, MS, USA
| | - Jessica E McClain
- School of Medicine, 21693University of Mississippi Medical Center, Jackson, MS, USA
| | - Adam C Parker
- School of Medicine, 21693University of Mississippi Medical Center, Jackson, MS, USA
| | - Brandon R Brousse
- Department of Medicine, 21693University of Mississippi Medical Center, Jackson, MS, USA
| | - David C Schaefer
- Department of Medicine, 21693University of Mississippi Medical Center, Jackson, MS, USA
| | - Matthew E Kutcher
- Department of Surgery, 21693University of Mississippi Medical Center, Jackson, MS, USA
| | - Jacob R Moremen
- Department of Surgery, 21693University of Mississippi Medical Center, Jackson, MS, USA
| |
Collapse
|
3
|
Mariotto R, Herbella FAM, Andrade VLÂ, Schlottmann F, Patti MG. VALIDATION OF A NEW WATER-PERFUSED HIGH-RESOLUTION MANOMETRY SYSTEM. ACTA ACUST UNITED AC 2021; 33:e1557. [PMID: 33503117 PMCID: PMC7836072 DOI: 10.1590/0102-672020200004e1557] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/20/2020] [Indexed: 11/22/2022]
Abstract
Background:
High-resolution manometry is more costly but clinically superior to conventional manometry. Water-perfused systems may decrease costs, but it is unclear if they are as reliable as solid-state systems, and reference values are interchangeable.
Aim: To validate normal values for a new water-perfusion high-resolution manometry system.
Methods:
Normative values for a 24-sensors water perfused high-resolution manometry system were validated by studying 225 individuals who underwent high resolution manometry for clinical complaints. Patients were divided in four groups: group 1 - gastroesophageal reflux disease; group 2 - achalasia; group 3 - systemic diseases with possible esophageal manifestation; and group 4 - dysphagia.
Results:
In group 1, a hypotonic lower esophageal sphincter was found in 49% of individuals with positive 24 h pH monitoring, and in 28% in pH-negative individuals. In groups 2 and 3, aperistalsis was found in all individuals. In group 4, only one patient (14%) had normal high-resolution manometry.
Conclusions:
The normal values determined for this low-cost water-perfused HRM system with unique peristaltic pump and helicoidal sensor distribution are discriminatory of most abnormalities of esophageal motility seen in clinical practice.
Collapse
Affiliation(s)
- Rogério Mariotto
- Department of Surgery, Federal University of São Paulo, SP, Brazil
| | | | - Vera Lucia Ângelo Andrade
- Department of Pathology, UninCor Faculty of Medicine, Vale do Rio Verde University, Belo Horizonte, MG, Brazil
| | | | - Marco G Patti
- Department of Medicine and Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
4
|
Đanić Hadžibegović A, Hergešić F, Babić E, Slipac J, Prstačić R. Thyroidectomy-related Swallowing Difficulties: Review of the Literature. Acta Clin Croat 2020; 59:38-49. [PMID: 34219883 PMCID: PMC8212616 DOI: 10.20471/acc.2020.59.s1.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This study aims to provide insight into the etiology and frequency of swallowing complications that arise after thyroidectomy and to outline the available diagnostic procedures by revising the existing literature on this topic. We conducted a bibliographic search using the electronic database MEDLINE/PubMed to identify all relevant articles and 44 studies were included in the review out of a total of 218 published articles. Dysphagia after thyroid surgery is a common postoperative complication which, in the short- or long-term, significantly affects patient life quality. There is no standard diagnostic protocol for thyroidectomy-related swallowing impairment. Among the reviewed studies, 8 questionnaires and 12 instrumental diagnostic tools were used to identify swallowing difficulties related to thyroid surgery. The Swallowing Impairment Index (SIS-6) was the most-used questionnaire. Fiberoptic endoscopy is a standard diagnostic tool performed prior and after thyroid surgery, primarily to identify changes in vocal fold mobility. Although instrumental findings usually reveal non-specific alterations of swallowing; swallowing videofluoroscopy and esophageal manometry can be the most helpful tools in further management of thyroidectomy dysphagia. In patients with thyroidectomy-related swallowing difficulties and suspected laryngopharyngeal reflux, 24-hour MII-pH metry should be performed.
Collapse
Affiliation(s)
| | - Filip Hergešić
- 1Clinical Department for ENT and Head and Neck Surgery, Zagreb University Hospital Centre, 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Croatia, 3School of Medicine, Zagreb University, Croatia, 4Faculty of Education and Rehabilitation Sciences University of Zagreb, Croatia
| | - Ema Babić
- 1Clinical Department for ENT and Head and Neck Surgery, Zagreb University Hospital Centre, 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Croatia, 3School of Medicine, Zagreb University, Croatia, 4Faculty of Education and Rehabilitation Sciences University of Zagreb, Croatia
| | - Juraj Slipac
- 1Clinical Department for ENT and Head and Neck Surgery, Zagreb University Hospital Centre, 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Croatia, 3School of Medicine, Zagreb University, Croatia, 4Faculty of Education and Rehabilitation Sciences University of Zagreb, Croatia
| | - Ratko Prstačić
- 1Clinical Department for ENT and Head and Neck Surgery, Zagreb University Hospital Centre, 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Croatia, 3School of Medicine, Zagreb University, Croatia, 4Faculty of Education and Rehabilitation Sciences University of Zagreb, Croatia
| |
Collapse
|
5
|
Characteristic analysis of Zenker's diverticulum incidentally detected on multimodal neck ultrasound. J Med Ultrason (2001) 2019; 47:279-285. [PMID: 31848772 DOI: 10.1007/s10396-019-00992-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Zenker's diverticulum (ZD) incidentally detected on neck ultrasound (US) could be easily misdiagnosed as a thyroid nodule and unnecessarily removed by surgical operation. It is a critical issue to identify the characteristics of ZD in clinical practice. METHODS We reported 10 cases of ZD diagnosed using multimodal US, and discussed the features of its multimodal US images extracted from grayscale sonograms, color Doppler flow imaging (CDFI), three-dimensional US (3D-US), and contrast-enhanced US (CEUS). RESULTS All lesions were heterogeneous in the posterior of the left thyroid. CDFI showed no blood flow within the lesions. The shapes and internal echoes of the masses changed when patients swallowed or drank. Performing CEUS or 3D-US for those with atypical US findings was complementary to make the final diagnosis. Importantly, multimodal US helped to diagnose suspected small lesions in three cases in which the barium esophagram tests proved negative. CONCLUSIONS The US features of ZD detected by multiple modes of US can help in the collection of comprehensive imaging information on ZD, which should be used proactively to facilitate the correct diagnosis and to avoid misdiagnosis of ZD.
Collapse
|
6
|
|
7
|
Abstract
Dysphagia is a symptom of swallowing dysfunction that occurs between the mouth and the stomach. Although oropharyngeal dysphagia is a highly prevalent condition (occurring in up to 50% of elderly people and 50% of patients with neurological conditions) and is associated with aspiration, severe nutritional and respiratory complications and even death, most patients are not diagnosed and do not receive any treatment. By contrast, oesophageal dysphagia is less prevalent and less severe, but with better recognized symptoms caused by diseases affecting the enteric nervous system and/or oesophageal muscular layers. Recognition of the clinical relevance and complications of oesophageal and oropharyngeal dysphagia is growing among health-care professionals in many fields. In addition, the emergence of new methods to screen and assess swallow function at both the oropharynx and oesophagus, and marked advances in understanding the pathophysiology of these conditions, is paving the way for a new era of intensive research and active therapeutic strategies for affected patients. Indeed, a unified field of deglutology is developing, with new professional profiles to cover the needs of all patients with dysphagia in a nonfragmented way.
Collapse
|
8
|
Ye-huan L, Shi-xu L, Yi-li Z, Ou-chen W, Xiao-hua Z. Unexpected esophageal diseases appeared in thyroid resections. World J Surg Oncol 2015; 13:131. [PMID: 25888936 PMCID: PMC4387597 DOI: 10.1186/s12957-015-0542-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 03/07/2015] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE In order to avoid the misdiagnosis of thyroid diseases, we need to discuss the clinical features and diagnostic methods of cervical esophageal cancer and Zenker's diverticulum. METHODS The clinical and laboratory data of seven cases were reviewed retrospectively, and in all cases, esophageal-related diseases were misdiagnosed as thyroid diseases preoperatively. Among them, two cases were cervical esophageal cancer metastasized to thyroids but initially, they were misdiagnosed as thyroid cancer. The other five cases were Zenker's diverticulum, but were originally diagnosed as nodular goiter, and two out of the five cases were found with calcification. They were all detected by ultrasound examination without any clinical feature of esophageal diseases. Previous literatures only reported five cases of thyroid metastasis and three cases of Zenker's diverticulum. RESULTS In both cases where cervical esophageal cancer metastasized to thyroid, anterior cervical neoplasm biopsy and surgical removal were performed followed by postoperative radiotherapy and chemotherapy. Both patients died from esophageal cancers in 7 and 15 months postoperatively. All five cases of Zenker's diverticulum received excision and repair without any postoperative complication or recurrence in the following 2 to 7 years. CONCLUSIONS Cervical esophageal cancer and Zenker's diverticulum may be misdiagnosed as thyroid disease. Careful and comprehensive diagnostic tests would be required to avoid misdiagnosis.
Collapse
Affiliation(s)
- Liu Ye-huan
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, South of Bai-xiang Street, Ou-hai District, 325000, Wenzhou, Zhejiang, People's Republic of China.
| | - Lyu Shi-xu
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, South of Bai-xiang Street, Ou-hai District, 325000, Wenzhou, Zhejiang, People's Republic of China.
| | - Zhou Yi-li
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, South of Bai-xiang Street, Ou-hai District, 325000, Wenzhou, Zhejiang, People's Republic of China.
| | - Wang Ou-chen
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, South of Bai-xiang Street, Ou-hai District, 325000, Wenzhou, Zhejiang, People's Republic of China.
| | - Zhang Xiao-hua
- Department of Oncology, The First Affiliated Hospital of Wenzhou Medical University, South of Bai-xiang Street, Ou-hai District, 325000, Wenzhou, Zhejiang, People's Republic of China.
| |
Collapse
|