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Anefalos A, Martinez CAR, Coy CSR. London Protocol under water-perfused HRM in a healthy population, towards novel 3D manometric parameters in an evaluation of anorectal functional disorders. BMC Gastroenterol 2024; 24:127. [PMID: 38575859 PMCID: PMC10996243 DOI: 10.1186/s12876-024-03207-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/18/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND/AIM London Protocol (LP) and Classification allied to high-resolution manometry (HRM) technological evolution has updated and enhanced the diagnostic armamentarium in anorectal disorders. This study aims to evaluate LP reproducibility under water-perfused HRM, provide normal data and new parameters based on 3D and healthy comparison studies under perfusional HRM. METHODS Fifty healthy (25 F) underwent water-perfused 36 channel HRM based on LP at resting, squeeze, cough, push, and rectal sensory. Additional 3D manometric parameters were: pressure-volume (PV) 104mmHg2.cm (resting, short and long squeeze, cough); highest and lowest pressure asymmetry (resting, short squeeze, and cough). Complementary parameters (CP) were: resting (mean pressure, functional anal canal length); short squeeze (mean and maximum absolute squeeze pressure), endurance (fatigue rate, fatigue rate index, capacity to sustain); cough (anorectal gradient pressure); push (rectum-anal gradient pressure, anal canal relaxation percent); recto-anal inhibitory reflex (anal canal relaxation percent). RESULTS No difference to genders: resting (LP, CP, and 3D); short squeeze (highest pressure asymmetry); endurance (CP); cough (CP, highest and lowest pressure asymmetry); push (gradient pressure); rectal sensory. Higher pressure in men: short squeeze (maximum incremental, absolute, and mean pressure, PV, lowest pressure asymmetry); long squeeze (PV); cough (anal canal and rectum maximum pressure, anal canal PV); push (anal canal and rectum maximum pressure). Anal canal relaxation was higher in women (push). CONCLUSIONS LP reproducibility is feasible under water-perfused HRM, and comparative studies could bring similarity to dataset expansion. Novel 3D parameters need further studies with healthy and larger data to be validated and for disease comparisons. KEY POINTS • London Protocol and Classification allied with the technological evolution of HRM (software and probes) has refined the diagnostic armamentarium in anorectal disorders. • Novel 3D and deepening the analysis of manometric parameters before the London Classification as a contributory diagnostic tool. • Comparison of healthy volunteers according to the London Protocol under a perfusional high-resolution system could establish equivalence points.
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Affiliation(s)
- Alexandre Anefalos
- Department of Surgery, FCM, State University of Campinas-UNICAMP, Campinas, SP, Brazil.
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Prichard DO, Fetzer J. Recto-anal Pressures in Constipated Men and Women Undergoing High-Resolution Anorectal Manometry. Dig Dis Sci 2023; 68:922-930. [PMID: 35727425 DOI: 10.1007/s10620-022-07590-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/04/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND In constipated individuals, high-resolution anorectal manometry (HRM) may suggest the presence of a defecatory disorder. Despite known physiological differences between men and women, our understanding of functional anorectal pathophysiology is based upon predominantly female cohorts. Results are generalized to men. AIMS To evaluate whether recto-anal pressure patterns in constipated men are similar to those in constipated women. METHODS The electronic health records at Mayo Clinic, Rochester were used to identify constipated adult patients, without organic anorectal disease, who had undergone HRM and balloon expulsion testing (BET) in 2018, 2019, and 2020. Comparative analyses were performed. RESULTS Among 3,298 constipated adult patients (2,633 women, 665 men), anal and rectal pressures were higher in men. Women more likely to have HRM findings suggestive of a defecatory disorder (39% versus 20%, P < 0.001). Women were more likely to exhibit a type 4 pattern (27% versus 14%, P < 0.001), and less likely to exhibit a type 1 pattern (14% versus 38%, P < 0.001), of dyssynergia. Men were more likely to have an abnormal balloon expulsion test (BET, 34% versus 29%, P = 0.006). Nominal logistic regression demonstrates that male sex, age over 50 years, reduced recto-anal gradient during simulated evacuation, and types 2 and 4 dyssynergia are associated with an abnormal BET. CONCLUSIONS In this large retrospective study, constipated men and women exhibited different patterns of dyssynergia both in the presence and absence of an abnormal BET. These findings were independent of sex-specific baseline physiological differences.
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Affiliation(s)
- David O Prichard
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Jeffrey Fetzer
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, USA
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Fox JC, Feighery AM, Fetzer JR, Prichard DO. Results of Anorectal Physiological Testing in Patients with Limited English Proficiency. Dig Dis Sci 2023; 68:750-760. [PMID: 36383270 DOI: 10.1007/s10620-022-07732-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with limited English proficiency (LEP) experience barriers to healthcare. These include language barriers and difficulty accessing medical subspecialties. Consequently, patients with LEP may be underrepresented, and may be more likely to have abnormal results, among individuals referred for anorectal testing. AIMS To explore whether differences exist in the results of high-resolution anorectal manometry (HRM), rectal sensory testing (RST), and balloon expulsion testing (BET) between patients with LEP and English proficiency (EP). METHODS The electronic health records at Mayo Clinic, Rochester were used to identify constipated patients without organic anorectal disease who had undergone anorectal testing in 2018, 2019, and 2020. The language spoken by the patients was determined. HRM, RST, and BET results were compared. Nominal logistic regression explored the influence of age, gender, test operator, and LEP on the likelihood of abnormal findings. KEY RESULTS Among 3298 patients (80% female, mean age ± standard deviation 46 ± 16 years), 67 (2%) had LEP. HRM measurements were similar in LEP and EP patients. However, LEP patients were more likely to have abnormal BET and RST. Logistic regression revealed that age (older than 50 years), gender, test operator, and LEP influenced the results of BET and RST, with LEP having the strongest influence. CONCLUSIONS Results of anorectal testing in constipated patients differ between LEP and EP patients. This is likely to represent a difference in disease prevalence between these groups, for example, due to referral bias, rather than a difference in physiology or a language barrier.
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Affiliation(s)
- Jean C Fox
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Aoife M Feighery
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey R Fetzer
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, USA
| | - David O Prichard
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, USA.
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Wang Z, Hou M, Yan L, Dai Y, Yin Y, Liu X. Deep learning for tracing esophageal motility function over time. Comput Methods Programs Biomed 2021; 207:106212. [PMID: 34126411 DOI: 10.1016/j.cmpb.2021.106212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 05/24/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Esophageal high-resolution manometry (HRM) is widely performed to evaluate the representation of manometric features in patients for diagnosing normal esophageal motility and motility disorders. Clinicians commonly assess esophageal motility function using a scheme termed the Chicago classification, which is difficult, time-consuming and inefficient with large amounts of data. METHODS Deep learning is a promising approach for diagnosing disorders and has various attractive advantages. In this study, we effectively trace esophageal motility function with HRM by using a deep learning computational model, namely, EMD-DL, which leverages three-dimensional convolution (Conv3D) and bidirectional convolutional long-short-term-memory (BiConvLSTM) models. More specifically, to fully exploit wet swallowing information, we establish an efficient swallowing representation method by localizing manometric features and swallowing box regressions from HRM. Then, EMD-DL learns how to identify major motility disorders, minor motility disorders and normal motility. To the best of our knowledge, this is the first attempt to use Conv3D and BiConvLSTM to predict esophageal motility function over esophageal HRM. RESULTS Test experiments on HRM datasets demonstrated that the overall accuracy of the proposed EMD-DL model is 91.32% with 90.5% sensitivity and 95.87% specificity. By leveraging information across swallowing motor cycles, our model can rapidly recognize esophageal motility function better than a gastroenterologist and lays the foundation for accurately diagnosing esophageal motility disorders in real time. CONCLUSIONS This approach opens new avenues for detecting and identifying esophageal motility function, thereby facilitating more efficient computer-aided diagnosis in clinical practice.
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Affiliation(s)
- Zheng Wang
- School of Mathematics and Statistics, Central South University, Changsha 410083, China; Science and Engineering School, Hunan First Normal University, Changsha 410205, China
| | - Muzhou Hou
- School of Mathematics and Statistics, Central South University, Changsha 410083, China
| | - Lu Yan
- Department of Gastroenterology of Xiangya hospital, Central South University, Changsha 410008, China
| | - Yuzhuo Dai
- School of Mathematics and Statistics, Central South University, Changsha 410083, China
| | - Yani Yin
- Department of Gastroenterology of Xiangya hospital, Central South University, Changsha 410008, China.
| | - Xiaowei Liu
- Department of Gastroenterology of Xiangya hospital, Central South University, Changsha 410008, China.
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Hoshino M, Omura N, Yano F, Yamamoto SR, Matsuda M, Yanaga K. Simultaneous diagnosis of familial achalasia: report of two cases. Surg Case Rep 2017; 3:62. [PMID: 28485000 PMCID: PMC5422213 DOI: 10.1186/s40792-017-0340-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/01/2017] [Indexed: 11/27/2022] Open
Abstract
Background Achalasia is a rare disease with a morbidity of 1 in 100,000, for which the exact mechanism of pathogenesis has not been clarified due to the small total number of patients. We herein report on our experience with two cases of familial achalasia in which the involvement of genetic inheritance was suspected. Case presentation These cases consist of a man in his thirties and his mother in her sixties. The son consulted the Department of Gastrointestinal Medicine at our institute with dysphagia, and an upper gastrointestinal endoscopy revealed a gastric submucosal tumor with a maximal diameter of approximately 50 mm. Achalasia was also strongly suspected due to the enlargement of the esophagus to the maximum transverse diameter of 55 mm by esophagography along with delayed clearance of barium. A detailed interview revealed prolonged mild dysphagia in his mother. Therefore, high-resolution manometry was carried out in both patients. As a result, peristaltic disorder was observed in the esophageal body in both the mother and son, leading to a definitive diagnosis of achalasia. For the son, total gastrectomy including the lower esophagus with Roux-en-Y reconstruction was performed. His postoperative course was uneventful, and the patient was discharged from hospital in remission on the 9th day following surgery and is currently undergoing follow-up as an outpatient. Conclusions We hereby report on a very rare case of familial achalasia that we experienced which may suggest a genetic element in the onset of achalasia, and reviewed the literature.
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Affiliation(s)
- Masato Hoshino
- Department of Surgery, Kasukabe Central General Hospital, 5-9-4 Midoricho, Kasukabe city, Saitama, 344-0063, Japan. .,Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Nobuo Omura
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Fumiaki Yano
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Se Ryung Yamamoto
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Minoru Matsuda
- Department of Surgery, Kasukabe Central General Hospital, 5-9-4 Midoricho, Kasukabe city, Saitama, 344-0063, Japan
| | - Katsuhiko Yanaga
- Department of Surgery, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan
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Abstract
The utilization of impedance technology has enhanced our understanding and assessment of esophageal dysmotility. Esophageal high-resolution manometry (HRM) catheters incorporated with multiple impedance electrodes help assess esophageal bolus transit, and the combination is termed high-resolution impedance manometry (HRIM). Novel metrics have been developed with HRIM-including esophageal impedance integral ratio, bolus flow time, nadir impedance pressure, and impedance bolus height-that augments the assessment of esophageal bolus transit. Automated impedance-manometry (AIM) analysis has enhanced understanding of the relationship between bolus transit and pressure phenomena. Impedance-based metrics have improved understanding of the dynamics of esophageal bolus transit into four distinct phases, may correlate with symptomatic burden, and can assess the adequacy of therapy for achalasia. An extension of the use of impedance involves impedance planimetry and the functional lumen imaging probe (FLIP), which assesses esophageal biophysical properties and distensibility, and could detect patterns of esophageal contractility not seen on HRM. Impedance technology, therefore, has a significant impact on esophageal function testing in the present day.
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Affiliation(s)
- Amit Patel
- Division of Gastroenterology, Duke University School of Medicine and the Durham Veterans Affairs Medical Center, 704 15th Street no. 221, Durham, NC, 27705, USA
| | - C Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, 660 South Euclid Ave., Campus Box 8124, Saint Louis, MO, 63110, USA.
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