1
|
Maronian N, Cabrera C, Dewey J, Meyer T. The Development of Head and Neck Cancer in Patients with the Isolated Complaint of Globus Pharyngeus. Laryngoscope 2024; 134:1147-1154. [PMID: 37737553 DOI: 10.1002/lary.31027] [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: 05/03/2023] [Revised: 07/20/2023] [Accepted: 08/22/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVES Globus pharyngeus (GP) is a perplexing problem that accounts for 4% of referrals to otolaryngologists. Workup can be extensive and may not be definitive in terms of etiology. The concern that lingers is that of a subtle cancer, which can prolong anxiety and increase testing cost. The aim of this study was to identify the incidence of head and neck cancer (HNC) in patients diagnosed with GP. METHODS Longitudinal data were captured from two academic institutions, identifying patients with a new diagnosis of globus pharyngeus in 2015. The patient cohort was tracked for at least 4 years to assure follow-up and ability to determine if a HNC developed. Additional demographic data was also collected to determine most common consults, treatments, and testing employed. RESULTS Excluding patients with previous diagnosis of HNC, 377 patients were identified who presented with GP in 2015 that had at least 4 years of follow-up. Demographics were predominantly women (64.65%), with a mean age of 56.48 years at diagnosis, and the most common provider specialty on the first visit was otolaryngology (39.52%). Four patients ultimately developed HN cancer, for an overall incidence of 1% for the 4-year period of 2015-2019. CONCLUSIONS Given the long-term follow-up of this population, the overall incidence of developing a head and neck cancer, with a presenting symptom of globus, is low. This is the largest study to date to report the percentage of patients endorsing GP to then subsequently develop HNC. This helps otolaryngologists to reassure patients who have a normal comprehensive exam, flexible endoscopy, and targeted studies. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1147-1154, 2024.
Collapse
Affiliation(s)
- Nicole Maronian
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A
| | - Claudia Cabrera
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A
| | - John Dewey
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, U.S.A
| | - Tanya Meyer
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, West Virginia, U.S.A
| |
Collapse
|
2
|
Kosztyła-Hojna B, Rogowski M, Duchnowska E, Zdrojkowski M, Łobaczuk-Sitnik A. Multidimentional assessment of voice quality in patients with laryngopharyngeal reflux disease. OTOLARYNGOLOGIA POLSKA 2023; 78:20-30. [PMID: 38332705 DOI: 10.5604/01.3001.0053.7519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
<b><br>Introduction:</b> Gastroesophageal Reflux Disease (GERD) is a common disorder in world population. As a result of the regurgitation of acid content from the stomach to laryngopharynx and larynx, secondary damage of laryngeal mucosa occur, which is highly sensitive to hydrochloric acid, and morphological changes are observed. Symptomatology of laryngopharyngeal reflux is varied which makes differential diagnosis difficult.</br> <b><br>Aim:</b> The aim of the study was the assessment of voice quality, morphological changes in larynx as well as etiology of Laryngopharyngeal Reflux Disease.</br> <b><br>Material and method:</b> The severity of dysphonia was classified using perceptual and acoustic methods as well as RSI. Morphological control was performed using HSDI technique and RFS. Etiological factors were examined basing on barofunction of upper esophageal sphincter and 24-hour pH-metry of air exhaled expressed in Ryan score.</br> <b><br>Results:</b> In the majority of patients with Laryngopharyngeal Reflux, dysphonia was recognized, intensified especially in women (G3R2B0A0S3), which was confirmed in Yanagihara classification (type III) and parameters of acoustic analysis. Voice disorders were the most frequently the result of edema and congestion of interarytenoid area, aytenoids and vocal folds. Those symptoms were caused by the decrease of upper esophageal sphincter tension and acidity of exhaled air which was confirmed in 24-hour pHmetry.</br> <b><br>Conclusions:</b> It is important to educate physicians and patients about the possibilty of negative impact of reflux disease on the occurrence of voice quality disorders. Current diagnostic methods for dysphonia guarantee accurate recognition and therapeutic success improving the prognoses of patients with Laryngopharyngeal Reflux.</br>.
Collapse
Affiliation(s)
- Bożena Kosztyła-Hojna
- Department of Clinical Phonoaudiology and Speech Therapy, Medical University of Bialystok, Poland
| | - Marek Rogowski
- Department of Clinical Phonoaudiology and Speech Therapy, Medical University of Bialystok, Poland
| | - Emilia Duchnowska
- Department of Clinical Phonoaudiology and Speech Therapy, Medical University of Bialystok, Poland
| | - Maciej Zdrojkowski
- Department of Clinical Phonoaudiology and Speech Therapy, Medical University of Bialystok, Poland
| | - Anna Łobaczuk-Sitnik
- Department of Clinical Phonoaudiology and Speech Therapy, Medical University of Bialystok, Poland
| |
Collapse
|
3
|
Sikavi DR, Cai JX, Leung R, Carroll TL, Chan WW. Impaired Proximal Esophageal Contractility Predicts Pharyngeal Reflux in Patients With Laryngopharyngeal Reflux Symptoms. Clin Transl Gastroenterol 2021; 12:e00408. [PMID: 34597279 PMCID: PMC8487779 DOI: 10.14309/ctg.0000000000000408] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/04/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The pathophysiology of laryngopharyngeal reflux (LPR) remains incompletely understood. Proximal esophageal motor dysfunction may impair bolus clearance, increasing the risk of pharyngeal refluxate exposure. We aimed to evaluate the association of proximal esophageal contractility with objective reflux metrics. METHODS We evaluated adults with LPR symptoms undergoing high-resolution manometry (HRM) and combined hypopharyngeal-esophageal multichannel intraluminal impedance-pH testing at a tertiary center between March 2018 and August 2019. Routine parameters per Chicago classification were obtained on HRM. Proximal esophageal contractility was evaluated using proximal contractile integral (PCI), which quantifies contractile pressure >20 mm Hg for the region spanning the distal margin of the upper esophageal sphincter and transition zone. Univariate (Kendall correlation and Student t test) and multivariable (general linear regression and logistic regression) analyses were performed. RESULTS We enrolled 138 patients (66.7% women, mean age 57.1 years) in this study. Lower PCI was associated with an elevated risk of increased pharyngeal reflux (adjusted odds ratio 0.83 per 100 mm Hg-s-cm change in PCI, 95% confidence interval: 0.69-0.98), with a trend toward increased bolus exposure time and total reflux events, after multivariable adjustment. The relationship between PCI and pharyngeal reflux was strongest among participants without a primary motility disorder on HRM (adjusted odds ratio 0.63, 95% confidence interval: 0.42-0.85, P interaction = 0.04). Among continuously expressed reflux parameters, lower PCI was significantly associated with more distal acid reflux events (β = -0.0094, P = 0.03) and total reflux events (β = -0.0172, P = 0.05), after adjusting for confounders. DISCUSSION Reduced proximal esophageal contractility as assessed by decreased PCI on HRM independently predicted increased pharyngeal reflux in patients with LPR symptoms, particularly among those without a coexisting motility disorder.
Collapse
Affiliation(s)
| | - Jennifer X. Cai
- Harvard Medical School, Boston, Massachusetts, USA;
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA;
| | - Ryan Leung
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA;
| | - Thomas L. Carroll
- Harvard Medical School, Boston, Massachusetts, USA;
- Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Walter W. Chan
- Harvard Medical School, Boston, Massachusetts, USA;
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA;
| |
Collapse
|
4
|
The upper esophageal sphincter in the high-resolution manometry era. Langenbecks Arch Surg 2021; 406:2611-2619. [PMID: 34462811 DOI: 10.1007/s00423-021-02319-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/26/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The evaluation of the upper esophageal sphincter (UES) has been neglected during routine manometric tests for decades, mostly due to the limitations of the conventional manometry which were eventually overcome by high-resolution manometry (HRM). METHODS This study reviewed the current knowledge of the manometric evaluation of the UES in health and disease in the HRM era. RESULTS We found that HRM allowed more precise measurements, in addition to the parameters as compared to conventional manometry, but most of them still need confirmation of the clinical significance. The parameters used to evaluate the UES were extension, basal pressure, residual pressure, relaxation duration, relaxation time to nadir, recovery time, intrabolus pressure, and deglutitive sphincter resistance. UES may be affected by different diseases: achalasia (UES is hypertonic with impaired relaxation), gastroesophageal reflux disease (UES is short and hypotonic), globus (UES ranges from normal to impaired relaxation to hypertonic), neurologic diseases (stroke and Parkinson - UES is hypotonic in early-stage to impaired relaxation in end-stage disease), and Zenker's diverticulum (UES has impaired relaxation). CONCLUSION This review shows that UES dysfunction is part of several disease processes and that the study of the UES is possible and valuable with the aid of HRM.
Collapse
|
5
|
Jehangir A, Tanner S, Malik Z, Parkman HP. Characterizing the proximal esophageal segment in patients with symptoms of esophageal dysmotility. Neurogastroenterol Motil 2020; 32:e13888. [PMID: 32485784 DOI: 10.1111/nmo.13888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/25/2020] [Accepted: 04/29/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Proximal esophageal striated muscle contractility may be abnormal in patients with esophageal symptoms, but is not assessed in the Chicago Classification (CC) v3.0. We aimed to (a) determine the prevalence of abnormal proximal esophageal contractility in patients with esophageal symptoms; (b) compare proximal esophageal contractility in patients with different esophageal motility disorders; (c) assess the association of abnormal proximal esophageal contractility with esophageal symptoms. METHODS Patients undergoing high-resolution esophageal manometry (HREM) from 7/2019 to 11/2019 and healthy volunteers (HVs) were studied. Measurements of the proximal esophageal segment included the vigor of contractility of the proximal esophagus (proximal contractile integral/PCI). Patients rated gastrointestinal symptoms' severity. KEY RESULTS HREM was performed on 221 patients (63.8% females, mean age 57.1 ± 1.1 years) and 19 HVs. Mean PCI in HVs was 299.5 ± 30.6 (95% CI 32.3-566.7 mm Hg. s. cm). Of all patients, 61 (27.6%) had abnormal PCI. HVs and patients with different esophageal motility disorders had significantly different PCI (P < .01). Type 1 achalasia patients had weaker PCI than patients with absent contractility (P = .02). Patients with abnormal PCI had more severe dysphagia (P = .02), nausea (P = .03), vomiting (P = .03), and lower bolus clearance (P < .01) than patients with normal PCI. CONCLUSIONS AND INFERENCES Abnormal PCI was found in a fourth of patients with esophageal symptoms. PCI may be useful to distinguish some esophageal motility disorders. Patients with abnormal PCI had a higher severity of some upper gastrointestinal symptoms than patients with normal PCI. Assessing the proximal esophageal segment on HREM may be useful in characterizing patients with esophageal symptoms.
Collapse
Affiliation(s)
- Asad Jehangir
- Gastroenterology Section, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Samuel Tanner
- Gastroenterology Section, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Zubair Malik
- Gastroenterology Section, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Henry P Parkman
- Gastroenterology Section, Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| |
Collapse
|
6
|
Yu Y, Wei R, Liu Z, Xu J, Xu C, Chen JDZ. Ameliorating Effects of Transcutaneous Electrical Acustimulation Combined With Deep Breathing Training on Refractory Gastroesophageal Reflux Disease Mediated via the Autonomic Pathway. Neuromodulation 2019; 22:751-757. [PMID: 31347247 PMCID: PMC6771489 DOI: 10.1111/ner.13021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 06/14/2019] [Accepted: 06/15/2019] [Indexed: 12/11/2022]
Abstract
AIMS To investigate the effects and possible mechanisms of transcutaneous electrical acustimulation (TEA) combined with deep breathing training (DBT) on refractory gastroesophageal reflux disease (rGERD). METHODS Twenty-one patients with rGERD were recruited and randomly assigned to receive either only esomeprazole (ESO, 20 mg bid) (group A, n = 7), TEA + DBT + ESO (group B, n = 7), or sham-TEA + DBT + ESO (group C, n = 7) in a four-week study. The reflux diagnostic questionnaire (RDQ) score and heart rate variability (HRV) were recorded and evaluated at baseline and at the end of each treatment. Blood samples were collected for the measurement of serum acetylcholine (Ach) and nitric oxide (NO). Esophageal manometry and 24-hour pH monitoring were performed before and after the treatment. RESULTS After treatment, 1) the participants in group B had significantly lower scores of RDQ and DeMeester and increased lower esophageal sphincter pressure (LESP) than those in group C (all p < 0.05), suggesting the role of TEA; 2) low frequency band (LF)/(LF + HF) ratio in groups B and C was decreased, compared with group A (p = 0.010, p = 0.042, respectively); high frequency band (HF)/(LF + HF) ratio in B and C groups was significantly increased, compared with group A (p = 0.010, p = 0.042, respectively); 3) The serum Ach in groups B and C was significantly higher than group A (p = 0.022, p = 0.046, respectively); the serum NO in groups B and C was significantly lower than group A (p = 0.010, p = 0.027, respectively). CONCLUSIONS TEA combined with the DBT can effectively improve the reflux symptoms in rGERD patients by increasing LESP and reducing gastroesophageal reflux, which may be mediated via the autonomic and enteric mechanisms.
Collapse
Affiliation(s)
- Yue Yu
- Department of Gastroenterology, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiAnhuiChina
| | - Ruiling Wei
- Department of Gastroenterology, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiAnhuiChina
| | - Zhi Liu
- Department of Gastroenterology, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiAnhuiChina
| | - Jiaqin Xu
- Department of Gastroenterology, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiAnhuiChina
| | - Chao Xu
- Department of Gastroenterology, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of ChinaHefeiAnhuiChina
| | - Jiande D. Z. Chen
- Division of Gastroenterology and HepatologyJohns Hopkins UniversityBaltimoreMAUSA
| |
Collapse
|
7
|
Abstract
Globus is an area of interest for many medical specialists including otorhinolaryngologists, gastroenterologist, allergists, and psychiatrists. It may be caused by an organic disease, but it is not uncommon that an underlying etiology remains unidentified even after a full workup has been performed. Patients who suffer from globus usually visit several physicians from different specialties without finding a solution for their symptoms. Identifying the underlying cause of globus is not always a simple task; therefore, structural or functional abnormalities of the thyroid, larynx, pharynx, and esophagus should be investigated. Gastroesophageal reflux disease is commonly considered to be the underlying cause after being identified in an otorhinolarygeal (ear, nose, and throat) evaluation, which is usually the first diagnostic step. In the last few years, an inlet patch in the proximal esophagus has been shown to be associated with globus, and its elimination has resulted in symptom resolution in some patients. Finally, globus can be associated with psychiatric disorders as well as oropharyngeal hypersensitivity that could be either chemical or mechanical. Treatment is directed toward an identified organic cause; in those with a functional disorder, the mainstay of therapy includes neuromodulators and psychiatric/psychological interventions.
Collapse
|
8
|
Tang Y, Huang J, Zhu Y, Qian A, Xu B, Yao W. Comparison of esophageal motility in gastroesophageal reflux disease with and without globus sensation. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 109:850-855. [PMID: 29082739 DOI: 10.17235/reed.2017.4449/2016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUNDS AND AIMS This study aimed to compare the esophageal motility between gastroesophageal reflux disease (GERD) patients with typical symptoms but without globus sensation and GERD patients only with globus symptoms. METHODS A total of 57 consecutive GERD patients diagnosed by endoscopy or by 24-hour pH monitoring between May 2013 and September 2015 were included retrospectively into the study. The patients were grouped based on the presence or absence of globus. Thirty patients presented with typical reflux symptoms but without globus were assigned to the typical GERD group and 27 patients only with globus symptom were assigned to the globus GERD group. All patients underwent esophageal high resolution manometry (HRM) and the differences in esophageal motility between the two groups were analyzed. RESULTS The globus GERD group showed a significantly greater lower esophageal sphincter (LES) length, LES basal pressure and upper esophageal sphincter (UES) residual pressure than that of the typical GERD group (3.47 ± 0.76 vs. 2.65 ± 0.62 cm, 21.71 ± 9.68 vs. 16.04 ± 8.49 mmHg, 7.30 ± 4.42 vs. 4.12 ± 2.92 mmHg, all p < 0.05). There was no significant difference between the two groups in terms of the distal wave amplitude, mean wave duration, distal contractile integral (DCI), contractile front velocity (CFV), distal latency (DL), integrated relaxation pressure (IRP) and UES basal pressure. The incidence of esophageal dysmotility in the globus GERD group (33.3%) was higher than in the typical GERD group (23.3%). There was no significant difference in esophageal acid exposure of the non-erosive gastroesophageal reflux disease (NERD) patients between the two groups. CONCLUSIONS Globus GERD patients have a higher UES residual pressure, longer LES length, higher LES basal pressure and greater esophageal dysmotility than typical GERD patients. HRM is useful in evaluating esophageal motility of GERD patients.
Collapse
Affiliation(s)
- Yuming Tang
- Department of Gastroenterology, Ruijin Hospital, China
| | - Jia Huang
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Ying Zhu
- Department of Gastroenterology, Ruijin Hospital, China
| | - Aihua Qian
- Department of Gastroenterology, Ruijin Hospital, China
| | - Bin Xu
- Department of Gastroenterology, Ruijin Hospital, China
| | - Weiyan Yao
- Department of Gastroenterology, Ruijin Hospital, China
| |
Collapse
|
9
|
Globus pharyngeus: a review of etiology, diagnostics, and treatment. Eur Arch Otorhinolaryngol 2018; 275:1945-1953. [DOI: 10.1007/s00405-018-5041-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/14/2018] [Indexed: 12/13/2022]
|
10
|
Li YW, Xie CX, Wu KM, Chen MH, Xiao YL. Motility characteristics in the transition zone in Gastroesophageal Reflux Disease (GORD) patients. BMC Gastroenterol 2016; 16:106. [PMID: 27576498 PMCID: PMC5006573 DOI: 10.1186/s12876-016-0525-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/18/2016] [Indexed: 01/10/2023] Open
Abstract
Background Defects in distal oesophageal peristalsis was thought to be an indication of incomplete bolus transit (BT). However, the role of transition zone (TZ) defects in the BT in gastroesophageal reflux disease (GORD) patients needs clarification. The aim of this study was to assess the TZ defects in GORD patients and to explore the relationship between TZ defects and BT. Methods One hundred and two patients with reflux symptoms and 20 healthy adults were included in the study. All subjects underwent upper gastrointestinal endoscopy, high resolution impedance manometry (HRiM) and 24-h ambulatory multichannel impedance-pH (MII-pH) monitoring. Patients were subgrouped into reflux oesophagitis (RE), non-erosive reflux disease (NERD), hypersensitive oesophagus (HO) and functional heartburn (FH) classified following MII-pH monitoring. Oesophageal pressure topography was analysed to define TZ defects by spatial or temporal TZ measurements exceeding 2 cm or 1 s, weak and fragmented swallows were excluded, and the association between TZ and BT was investigated. Results Following liquid swallows, there were no significant differences in TZ delay time and TZ length between groups (RE: 1.75 s (1.32–2.17) and 2.50 cm (2.40–3.20); NERD: 1.60 s (1.10–2.00) and 2.20 cm (2.10–2.65); HO: 1.60 s (1.30–1.80) and 2.70 cm (2.30–3.00); FH: 1.55 s (1.20–2.17) and 3.10 cm (2.25–5.00); Healthy volunteers: 1.50 s (1.20–1.90) and 2.30 cm (2.10–3.00). However, individuals with TZ defects had lower complete BT rates compared with those without TZ defects (p < 0.001). There were also significantly more incomplete BT in patients with RE, HO and FH than in healthy controls (p < 0.05). Conclusions In GORD patients, TZ defects correlated with proximal bolus retention in the corresponding area independent of distal weak peristalsis. Electronic supplementary material The online version of this article (doi:10.1186/s12876-016-0525-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Yu-Wen Li
- Department of Gastroenterology, First affiliated Hospital, Sun Yat-sen University, Guangzhou, GuangDong Province, 510080, People's Republic of China.,Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, The University of Queensland, Brisbane, QLD, 4102, Australia
| | - Chen-Xi Xie
- Department of Gastroenterology, First affiliated Hospital, Sun Yat-sen University, Guangzhou, GuangDong Province, 510080, People's Republic of China
| | - Kai-Ming Wu
- Gastrointestinal Surgery Center, First affiliated Hospital, Sun Yat-sen University, Guangzhou, GuangDong Province, 510080, People's Republic of China
| | - Min-Hu Chen
- Department of Gastroenterology, First affiliated Hospital, Sun Yat-sen University, Guangzhou, GuangDong Province, 510080, People's Republic of China.
| | - Ying-Lian Xiao
- Department of Gastroenterology, First affiliated Hospital, Sun Yat-sen University, Guangzhou, GuangDong Province, 510080, People's Republic of China.
| |
Collapse
|
11
|
Bitnar P, Stovicek J, Andel R, Arlt J, Arltova M, Smejkal M, Kolar P, Kobesova A. Leg raise increases pressure in lower and upper esophageal sphincter among patients with gastroesophageal reflux disease. J Bodyw Mov Ther 2016; 20:518-24. [DOI: 10.1016/j.jbmt.2015.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 11/16/2015] [Accepted: 12/01/2015] [Indexed: 01/12/2023]
|
12
|
Nevalainen P, Walamies M, Kruuna O, Arkkila P, Aaltonen LM. Supragastric belch may be related to globus symptom - a prospective clinical study. Neurogastroenterol Motil 2016; 28:680-6. [PMID: 26744292 DOI: 10.1111/nmo.12764] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/02/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND The etiology of globus is poorly understood. It is controversial, whether gastroesophageal reflux disease (GERD) has a role in globus. To investigate the possible esophageal background of this symptom, we performed transnasal esophagoscopy (TNE), high-resolution manometry (HRM), and 24-h multichannel intraluminal impedance (MII) and pH monitoring on globus patients. METHODS Thirty consecutive patients were referred to Helsinki University Hospital, Department of Otorhinolaryngology - Head and Neck Surgery for treatment of globus; 24 consecutive patients with difficult reflux symptoms from the Department of Surgery served as controls. We compared the results of the patient groups in endoscopies, HRM, and 24-h MII-pH monitoring. KEY RESULTS In MII monitoring, globus patients had supragastric belch (6/20, 30% vs 1/24, 4%; p = 0.038) more often than controls. Total reflux time was higher in controls (p = 0.004), and they had more acid reflux events (p = 0.002) in MII, but between groups, the number of non-acid reflux events was similar. In pH monitoring, DeMeester score and total pH <4 time were higher in controls (P < 0.001). In HRM, the upper esophageal sphincter (UES) mean basal and residual pressures did not differ. CONCLUSIONS & INFERENCES Supragastric belch was more common in globus patients, suggesting the possible role of this condition in globus sensation. However, globus patients in this series had no acid or non-acid GERD or elevated UES pressure.
Collapse
Affiliation(s)
- P Nevalainen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M Walamies
- Department of Clinical Physiology and Nuclear Medicine, Helsinki University Hospital Medical Imaging Centre, Helsinki, Finland
| | - O Kruuna
- Pathology and Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P Arkkila
- Department of Gastroenterology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - L-M Aaltonen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
13
|
Abstract
Swallowing disorders (dysphagia) have been recognized by the WHO as a medical disability associated with increased morbidity, mortality and costs of care. With increasing survival rates and ageing of the population, swallowing disorders and their role in causing pulmonary and nutritional pathologies are becoming exceedingly important. Over the past two decades, the study of oropharyngeal dysphagia has been approached from various disciplines with considerable progress in understanding its pathophysiology. This Review describes the most frequent manifestations of oropharyngeal dysphagia and the clinical as well as instrumental techniques that are available to diagnose patients with dysphagia. However, the clinical value of these diagnostic tests and their sensitivity to predict outcomes is limited. Despite considerable clinical research efforts, conventional diagnostic methods for oropharyngeal dysphagia have limited proven accuracy in predicting aspiration and respiratory disease. We contend that incorporation of measurable objective assessments into clinical diagnosis is needed and might be key in developing novel therapeutic strategies.
Collapse
Affiliation(s)
- Nathalie Rommel
- KU Leuven, Department of Neurosciences, Experimental Otorhinolaryngology, B-3000 Leuven, Belgium
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, Clinical Sciences Building, Salford Royal Hospital, Eccles Old Road, Salford M6 8HD, UK
| |
Collapse
|
14
|
Jones CA, Ciucci MR, Hammer MJ, McCulloch TM. A multisensor approach to improve manometric analysis of the upper esophageal sphincter. Laryngoscope 2015; 126:657-64. [PMID: 26297859 DOI: 10.1002/lary.25506] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 05/22/2015] [Accepted: 06/22/2015] [Indexed: 01/29/2023]
Abstract
OBJECTIVES/HYPOTHESIS High-resolution manometry (HRM) improves on previous manometric systems by including a greater number of sensors that are more densely placed. Due to deglutitive movement of the HRM catheter and upper esophageal sphincter (UES), it is unclear which HRM sensors capture pressure in the UES. To address this issue, we present two complementary studies to describe UES pressure patterns using HRM + videofluoroscopy and HRM + electromyography (EMG). STUDY DESIGN Case series involving a new analysis method. METHODS Study 1: Simultaneous HRM + videofluoroscopy were performed in 11 healthy subjects swallowing five 10-mL thin-liquid boluses. HRM catheter and UES movement were tracked to identify UES pressure patterns over multiple HRM sensors. Study 2: Simultaneous HRM + cricopharyngeal EMGs were performed in six healthy subjects swallowing five 10-mL water boluses. HRM and EMG outputs were correlated over individual and multiple HRM sensors. RESULTS HRM sensors move prior to UES movement (P < .001) and to a lesser extent in rostral and ventral directions (P ≤ .01) than the UES. UES closure pressure is captured with two distinct patterns: 1) a rostral UES pattern with short durations and fast rate of pressure release, depicting UES descent along the catheter as it closes; and 2) a caudal UES pattern with tonic pressures at baseline and a deglutitive nadir. The HRM + EMG multisensor correlation (r = 0.88) was significantly stronger than the single-sensor correlation (r = 0.80; P = .02). CONCLUSIONS During deglutition, the HRM catheter and the UES rise above baseline positions and create a distinctive, multisensor manometric trace. Accurate deglutitive UES pressure evaluation must include multiple manometric sensors. LEVEL OF EVIDENCE 4 Laryngoscope, 126:657-664, 2016.
Collapse
Affiliation(s)
- Corinne A Jones
- Department of Surgery, Division of Otolaryngology
- Department of Communication Sciences and Disorders
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | - Michelle R Ciucci
- Department of Surgery, Division of Otolaryngology
- Department of Communication Sciences and Disorders
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | | | - Timothy M McCulloch
- Department of Surgery, Division of Otolaryngology
- Department of Communication Sciences and Disorders
| |
Collapse
|
15
|
van Hoeij FB, Smout AJ, Bredenoord AJ. Predictive value of routine esophageal high-resolution manometry for gastro-esophageal reflux disease. Neurogastroenterol Motil 2015; 27:963-70. [PMID: 25930019 DOI: 10.1111/nmo.12570] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 03/18/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Using conventional manometry, gastro-esophageal reflux disease (GERD) was associated with a reduced lower esophageal sphincter (LES) pressure and impaired peristalsis. However, with a large overlap between GERD patients and controls, these findings are of limited clinical relevance. It is uncertain whether the more detailed information of high-resolution manometry (HRM) can discriminate GERD patients. Therefore, we aimed to determine to which extent HRM findings can predict GERD. METHODS HRM measurements in 69 patients with GERD and 40 healthy subjects were compared and the predictive value of HRM for the diagnosis of GERD was explored. KEY RESULTS GERD patients had a significantly lower contraction amplitude (55 vs 64 mmHg; p = 0.045) and basal LES pressure (10 vs 13.2 mmHg; p = 0.034) than healthy controls. GERD patients more often had a hiatal hernia than healthy subjects (30% vs 7%; p = 0.005). Patients with reflux esophagitis had a lower DCI than patients without reflux esophagitis (558 vs 782 mmHg cm s; p = 0.045). No significant difference was seen in contractile front velocity, distal latency, number of peristaltic breaks, residual LES pressure and LES length. On multivariate logistic regression analysis, both esophagogastric junction type I (OR 4.971; 95% CI 1.33-18.59; p = 0.017) and mean wave amplitude (OR 0.95; 95% CI 0.90-0.98; p = 0.013) were found to be independent predictors of GERD. However, the sensitivity and specificity of these findings were low. CONCLUSIONS & INFERENCES Hiatal hernia, low contraction amplitude and LES pressure are associated with GERD, but do not predict the disease with sufficient accuracy. Routine esophageal HRM can therefore not be used to distinguish GERD patients from healthy subjects.
Collapse
Affiliation(s)
- F B van Hoeij
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - A J Smout
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - A J Bredenoord
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
16
|
Hasan Y, Go J, Hashmi SM, Valestin J, Schey R. Influence of everyday bolus consistencies in different body positions on high-resolution esophageal pressure topography (HREPT) parameters. Dis Esophagus 2015; 28:246-52. [PMID: 24506238 DOI: 10.1111/dote.12186] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The standard protocol for esophageal manometry involves placing the patient in the supine position with head turned to left (supine head left [SHL]) while evaluating liquid bolus swallows. Routinely, semisolid or solid boluses are not evaluated. Currently, the daily American diet includes up to 40% solid or semisolid texture. Thus far, the data on the effect of different bolus on high-resolution esophageal pressure topography (HREPT) parameters are scarce. This study aims to evaluate the effect of every day bolus consistencies in different body positions on HREPT variables. HREPT was performed on healthy volunteers with a modified protocol including liquid swallows in the SHL position followed by applesauce (semisolid), cracker (solid), and marshmallow (soft solid) in three different positions (SHL, sitting, and standing). A total of 38 healthy adult subjects (22 males and 16 females, median age = 27, and mean body mass index = 25) were evaluated. The resting upper esophageal sphincter pressure was significantly different while subjects swallowed crackers, applesauce, and marshmallows in most positions compared with liquid SHL (P < 0.05). The lower esophageal sphincter, contractile front velocity, and distal contractile integral pressures did not differ in all different consistencies compared with SHL. The integrated relaxation period was significantly higher with solid bolus compared with liquid bolus only in SHL position. The intrabolus pressure was significantly different with solid and soft solid boluses in all postures compared to liquid SHL. The American diet consistency affects upper esophageal sphincter pressure and partially integrated relaxation period and intrabolus pressure in various positions. Semisolid bolus swallows do not cause substantial pressure changes and are safe for evaluation and maintaining adequate caloric intake in patients with dysphagia who cannot tolerate solids.
Collapse
Affiliation(s)
- Y Hasan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | | | | | | | | |
Collapse
|