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Naguib GG, Hassan M, Elshafie AI, Naguib MG. Esophageal motility abnormalities in Egyptian patients using high resolution esophageal manometry: a descriptive study. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.1186/s43162-021-00097-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background and aim
For many years, esophageal manometry has been used for assessment of upper gastro-intestinal (GI) symptoms. Chicago classification is the key for diagnosis and managing motility disorders as it is considered as a standardized approach for categorization of esophageal abnormalities. The aim of this study is to analyze types of esophageal motility findings in Egyptian cases who were suffering from upper GI complaints. Methods: This descriptive study included 378 subjects who were suffering from upper GI complaints as dysphagia, vomiting, chest pain and regurgitation in the period between 10/2015–7/2020. Esophageal HRM study was performed for all patients (MMS Laborie device). The catheter was positioned and confirmed passing across the EGJ (esophago-gastric junction) using landmarks. Swallows and resting status were recorded. Anatomical landmarks were placed.
Results
Most of the patients were complaining of upper GI symptoms. Males were 49.2% of cases. Mean age was 41.3. Dysphagia was the prominent symptom while chest pain was the least symptom. Many manometry findings were observed including ineffective motility, achalasia, absent contractility, EGJ outflow obstruction, jackhammer esophagus and normal findings. Type II achalasia was the dominant type in achalasia patients while Type III was the least. LES was normotensive in most of the cases. Hiatus hernia (HH) was detected in 40.2% of the cases.
Conclusion
This is considered the first Egyptian descriptive study to determine the prevalence of esophageal motility abnormalities in Egyptian patients complaining of upper GI symptoms. HRM is very important for patients complaining of upper GI symptoms.
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Taft TH, Carlson DA, Simons M, Zavala S, Hirano I, Gonsalves N, Pandolfino JE. Esophageal Hypervigilance and Symptom-Specific Anxiety in Patients with Eosinophilic Esophagitis. Gastroenterology 2021; 161:1133-1144. [PMID: 34153298 PMCID: PMC8463417 DOI: 10.1053/j.gastro.2021.06.023] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/01/2021] [Accepted: 06/11/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patient symptom reporting often does not correlate with the pathophysiological markers of esophageal disease, including eosinophilic esophagitis (EoE). Esophageal hypervigilance and symptom-specific anxiety are emerging as important considerations in understanding symptom reporting. As such, we aimed to conduct the first study of these constructs in EoE. METHODS A retrospective review of an EoE patient registry was conducted and included eosinophils per high power field (from esophagogastroduodenoscopy biopsy: proximal, distal), endoscopic reference score, distal distensibility plateau (functional luminal imaging probe), Brief Esophageal Dysphagia Questionnaire, Visual Dysphagia Question of EoE Activity Index, Northwestern Esophageal Quality of Life scale, and the Esophageal Hypervigilance and Anxiety Scale. Correlational and regression analyses evaluated relationships of hypervigilance and anxiety with Brief Esophageal Dysphagia Questionnaire, Visual Dysphagia Question of EoE Activity Index, and Northwestern Esophageal Quality of Life scale when controlling for histology and endoscopic severity. RESULTS One hundred and three patients had complete data, 69.9% were male, and the mean (SD) age was 40.66 (13.85) years. Forty-one percent had elevated dysphagia and 46% had elevated hypervigilance and anxiety. Esophageal symptom-specific anxiety emerged as the most important predictor of Brief Esophageal Dysphagia Questionnaire severity (44.8% of the variance), Visual Dysphagia Question of EoE Activity Index severity (26%), and poor health-related quality of life (HRQoL) (55.3%). Hypervigilance was also important, but to a lesser extent. Pathophysiological variables did not significantly predict symptoms or HRQoL. Recent food impaction can predict symptom-specific anxiety and proton pump inhibitor use can reduce hypervigilance. CONCLUSIONS Hypervigilance and symptom-specific anxiety are important for our understanding of self-reported patient outcomes in EoE. These processes outweigh endoscopic and histologic markers of EoE disease activity across dysphagia, difficulty eating, and HRQoL. Clinicians should assess hypervigilance and anxiety, especially in patients with refractory symptoms and poor HRQoL.
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Roman S, Guadagnoli LA, Hastier A, Becam E, Craven MRA, Pandolfino JE, Napoléon M, Carlson DA, Mion F, Taft T. Validation in French of the Brief Esophageal Dysphagia Questionnaire in Patients Referred For Esophageal Manometry. Dysphagia 2021; 37:392-398. [PMID: 33830347 DOI: 10.1007/s00455-021-10290-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/25/2021] [Indexed: 12/30/2022]
Abstract
A brief esophageal dysphagia questionnaire (BEDQ) was recently developed in English to evaluate frequency and intensity of dysphagia. Our aim was to validate this questionnaire in French in a cohort of patients referred for esophageal manometry. Patients referred for esophageal high resolution manometry were offered to fill out different questionnaires including Eckart score, GERDQ score and BEDQ. BEDQ was translated in French by two French native speakers and experts in esophageal motility. Patients were grouped according to the indications of esophageal high resolution manometry (dysphagia, GERD, others). The total BEDQ score was calculated and compared between groups. The validation method used the assessment of internal consistency with Cronbach's alpha and reliability with Guttman split-half reliability. BEDQ questionnaire was completed by 608 patients (44% males, mean age 54 years). The total score had an excellent internal consistency (Cronbach's alpha = 0.90) and reliability (Guttman statistic = 0.92). The correlation was good with Eckardt score (r = 0.65, p < 0.001) but poor with the GERDQ score (r = 0.21, p < 0.01). Patients referred for dysphagia (n = 197) had an Eckardt score and a BEDQ score significantly higher than those referred for GERD or other indications (5.48 vs 3.65 and 3.53 respectively for Eckardt score and 15.85 vs 4.64 and 5.78 for BEDQ, p < 0.001). BEDQ is a valid questionnaire in French to assess dysphagia in clinical practice. It remains to be determined if this score is sensitive to symptom variation and thus useful for the follow up of patients with dysphagia.
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Affiliation(s)
- Sabine Roman
- Hospices Civils de Lyon, Explorations Fonctionnelles Digestives, Hopital E Herriot, Digestive Physiology, 5, place d'Arsonval, 69437 cedex 03, Lyon, France.
- Université Claude Bernard Lyon I, Explorations Fonctionnelles Digestives, Lyon, France.
| | - Livia Anna Guadagnoli
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Audrey Hastier
- Hospices Civils de Lyon, Explorations Fonctionnelles Digestives, Hopital E Herriot, Digestive Physiology, 5, place d'Arsonval, 69437 cedex 03, Lyon, France
| | - Estelle Becam
- Hospices Civils de Lyon, Explorations Fonctionnelles Digestives, Hopital E Herriot, Digestive Physiology, 5, place d'Arsonval, 69437 cedex 03, Lyon, France
| | - Meredith Ruth Ann Craven
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - John E Pandolfino
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Marie Napoléon
- Hospices Civils de Lyon, Explorations Fonctionnelles Digestives, Hopital E Herriot, Digestive Physiology, 5, place d'Arsonval, 69437 cedex 03, Lyon, France
| | - Dustin A Carlson
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Francois Mion
- Hospices Civils de Lyon, Explorations Fonctionnelles Digestives, Hopital E Herriot, Digestive Physiology, 5, place d'Arsonval, 69437 cedex 03, Lyon, France
- Université Claude Bernard Lyon I, Explorations Fonctionnelles Digestives, Lyon, France
| | - Tiffany Taft
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, USA
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