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4 P Oro-esophageal transit and motility disorders in dysphagic patients with connective acute disease: Simultaneous manometric and radioisothopical study
MOTILITYAND NERVE-GUT INTERACTIONS
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DIGEST LIVER DIS 2002;341SUPPL.11:R103-5
3P A PROSPECTIVE STUDY OF CHANGES IN THE QUALITY OF LIFE AFTER PNEUMATIC DILATION FOR AC-ASIA s CAMPO, P CERRO, A ZULLO, C “ASSAN, G BALSAMO, M DE MATTHAIES, R LORENZETTI, S MORINI
COMPARISON OF LINEAR INTERPOLATION AND POWER EXPONENTIAL MODEL IN THE ANALYSIS OF SIMPLIFIED GASTRIC EMPTYING BY SCINTIGRAPKY B P Mullan, D D. Burton, M.R Rank, M Camillen
OSPEDALE NUOVO REGINA MARGHERITA Mayo Clinic and Foundatmn BACKGROUND Pneumaticdilation (PO) is an effective treatmentto relieve dysphagiaand lower esophagealsphincter &ES) obstrucuon in achahwa. Aim ofthe study was to assess modificationsof quality of life (QOL) of patientswith achalasiabefore and a&r PD METHODS- Eighteen consecutivepatientswith achalasia(6 males.12females,mean age 48+/-16, range24-80) treated by PD were prospectwely eoroUed.PD was performed under tluoroscopic control using a 30 mm Rigi& dilator for a standardtiming dilation of 3 minutes Shortform 36 (SF-36) questionmirewas usedto assessQOL before and 3 months following PD RESULTS Mean ,&es (+,-SD) of basaland post treatmentlower esophageal sphmcterpressure decreasedsigrdficantlyfrom 3O+/-9 to 14+/-l mmHg (PC0 M)I) No complicationswere observedand no patientsrequiredsurgery After PD a stgmticam improvementwas obrcrved for 8 out of 9 QOL parameters,namelya) physicaltimctrooing (P=O.O36),b) role limitation dueto physical function (P=&C+O9);c) physical pain (p=O OM)7),d) generalhealth perception (F’=O.OC@S); e) energy Q-0 0063), r) role limitatton due to emotionalproblems(P=O 004); g) mentalhe&h (P=O WI I), h) changein health (P=O 0002). whereasthe parameterregardingsociallimction did not differ before and after PD (P=O4) CONCLUSIONS Our study showedthat PD significartly improved QOL in patientswth achalasiaFunher follow-up is ongoingto evaluatewhether this improvement is sustainedin a long-term period
Background & Aims: Scintigraphy is the gold standard for studvinn aastric emotinn Protocols are not well standardized, hut recent data surest that by reducing the nurhder zf scans the technique becomes more applicable and cost-effective m clinical ore&e Towas et al (Am 1 Gastroenterol2000.95:78-86) suzzest “sine. power expone&ial analysis to calculate gastric half-emptying time (t 112)‘We~ompuedr&dts of power exponential model and linear interpalstion for assessing t I12 and t lag endpoints when gastric emptying is performed using only 4 observation points Patients and methods 37 healthy volunteers underwent scintigraphy for gastric emptying using 99m Tosulphur colloid eggmeal Anterior and posterior gamma-cameraimages were taken at 0, I, 2, 4 hours from the labeled meal ingestion Gastric emptying endpoints were calculated from count ofpercent of isotope remaining in the stomach at 1, 2, 4 hours Both linear interpolation andthe power exponential model [defined as Prop t=(-(kt)^ p), were Prop t is the proportion of retention at time t], were used to calculate t II2 and lag phase Lag phasewas the time at which 5% of the isotope left the stomach. Differences in t l/2 and lag phasev&es calculated with the two techniques were. obtamed for each subject and were Comparedusing paired Wilcoxon test Resuhv Power exponential ‘s goodness of fit for the data points was optimal (median Rsquare 96, IQR 93- 98) t l/2 and lag phasevalues obtamed with linear interpolatioo, power exponential model and differences in these parameters (Deltas) are shown in Table t l/2 results by the two methods arevirtually identical The Deltas for t l/2 calculated with the two methods were significantly lower than the Deltas for the Lag phase @< 001) Conclusions: Power exponential model for calculating gastric half emptying-time from 4 observations can be replicated by simple linear interpolation. For cakulation of lag phase with 4 observations, linear interpolation andpower exponential model differ substantially and, given the goodness of fit tiom the power exponential analysis, the latter method may provide a better estimate oft lag than linear interpolation.
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Endpoint Medmn T~o(mms) (IQR) Median Lag phase (tins)
VQR)
Linear interpolation 105 (82 5-142 5) 144 (5.9-24 4)
Power exp model 1047 (84 8-132 5) 24 3 (I9 7-33 6)
Median Deltas
(*QR) 2.8 (0 9-5 9) I25 (9.0-15 7)
2P NON-CARDIAC CHEST PAIN (NCCP) IN PATIENTS WITH NON-EROSIVE REFLUX DISEASE (NERD)EROSIVE DISEASE A INDRIOLO, F NEGRINI, S SIGNORBLLI, M STP.AZABOSCO GASTROENTEROLOGIA
OSPEDAL.1RJUNlTI DI BERGAMO
GestroesophageaIreflox diseaseis presentin many patientswith recurrent chest pain of noncardiac origin In half of thesep&z+ no esophagi&is presentat endascopy(non erosive r&lx disease NERD, We haveinvestigatedthe circadianpattern ofgastro-esophagealretlux in patientswith non cardiac chest pain (NCCP) andNERD as comparedto patientswith NCCP and erosive Methods Seveotysevenconsecutivepatientswith NCCP (45 males,32 females,meanage47 ye. range20-70 yr) were evtiated After clinicalevaluation all padentswere submittedfo upper gastrointestinalendoscopyandesophageal24-hrs pH-monitoring The total tame r&m, upright iie reflox endsupinetime retlox were evaluatedRetlox diseasewes consideredpresemwhen total time percentagewith pH<4 was beyondth 95th percentdefor healthyasymptomaticcontrols (4%) ResultsAmong forrysix patients(6@/.) showingabonormalrefly 24 pts (52%), had NERD, whilst 22 pts (48%) showederosivediseaseAcid retlux was presentin 10% of total time in patientswith erosive disease,ascomparedto 7% in NERD patients In theupright positionabonommlrefhm was presentin 15124patients(62%) in NERD patventsand m 12122patients(54%) with erosive disease@=NS) In the supinepositionabnormalreflux was presentin 17124(71%) NERD patientsandin 18/22(83%) patientswith esophagitis Combinedupright andsupineretlux was presentm 7124(32%) NERD patwds andin I l/22 (50%) patientswith erosive disease@=NS). During the’24 hour ambulatoryesophagealpHmonitoringchest pain was present in 9 (37%) NERD patientsand6 (27%) patientswith erosive disease@=NS). Neither patientswith normalreflux experiencedchest pain during the 24 hour ambulatoryesophagealpH-momtoring ConclusmnPathological acidreflux was presentin 60% of patientsreffered for NCCP, in this group ofpatients, aud reflex in the supinepositionwas the prevalentpattern Inter>y, no sigoificaotditTerenceswere found in reflux time as well ar in the circadian patternbetweenpatleotswith erosive andnon erosivedisease Local factors may be relevant in determiningtheesophagealmucosalresponse
ORO-ESOPHAGEAL TRANSIT AND MOTILlTY DISORDERS IN DYSPHAGIC PATIENTS WITH CONNECTlVE ACUTE DISEASE SIMULTANEOUS MANOMETRIC AND RADIOISOTHOPICAL STUDY G Caliperi,M Pod, E Pustorino, G Luua, 0 Guerrisi. S Pwtorino D~partbnentoClioico Sperimentaledi Medicina eFarmacologia,Universit&di Messina. Background DysphagiaIScommon fmdmg m Connectivetissue disease,oflen associatedwth esophagealperistalsisdisorders, probably, for theu high prevalencein coonective ussue disease. Aim to determine,with a simultaneousmaoometricand radioisothopicalstudy, the dynamics of esophagealcleermg andthe possiblerelationship between transit vdocity of the b&s and manometriccharacteristics of the post-swallowing peristalticsequence Patientsand methods e@t femalepatients,meanage 42,5years (range 19.64 ), with B diagnosisof connectivetissue disease(6 with xleroderma and2 with mixedconnective tissue disease),all complainingwith recurrent chronic dysphasia,5 for solids, 3 for liquids and solids,were enrolled The study was performed onpatientsin supineposition.The traosit of a marked bolosandthe characteristics of the peristaltic sequencewere evaluatedby gamma-cameraand a standardesophagealmanometryrespectively The patientswere invited to swalIow 200 mCi of 99Tc-colloidal solphure,diluted in 10 ml of water, andthento performe 8 dry deglutitions,every I5 seconds, for 2 minutes.Sincethe first deglutition, serial frame by frameimageswere recorded for onesecond eachfor all recondmgperiod. Three areas ofinterest were beenselected proximal, middle anddistalesophagus.In each area the first I5 secondsperiod from the bolos swaUotin8 andthe remaioiog 2 minutes period were separatetyevaluated Results the first contractton followmg the marked b&s deglutition resultedprogressive in 5 oatieotr and simultaneousin 3 oatients The transit WBSslow in 6 oatiemsin the oroximal Lea, in 3 patientsin the middl; area andin 4 patientsin the disti area ’ A percentage> 20% of simultaneouswaves (ranpe37.5.100%) during the seriesof 8 dry deelutitions was detectedm 4 oatieots a slow traosit was detectedin the oraximal a~eain 5 patients,in the middle areain j patientsand in the dwal aream 4 patients ‘No relationslup was foundbetweenthe transit alterationand the severity of the esophagealmotor disorders Conclusion:In patimtr with dvsohaaiaandconnectivetissue diseasethe transit alterations. especiallydm& the early phasesof-emptying seemmore frequentin proximal thanin middle anddistal esophagus,independentlyfrom the presenceof peristaltic alterations In such patientsB possiblemechanismmight becoonectedto elteretiom of the transfer and the ejectionpower of the bolus in esophagus These alterationsmight be responsible,at least pamally,for the dysphagm
A103
.P
DIGEST LIVER DIS 2002;341SUPPL.11:R103-5
3P A PROSPECTIVE STUDY OF CHANGES IN THE QUALITY OF LIFE AFTER PNEUMATIC DILATION FOR AC-ASIA s CAMPO, P CERRO, A ZULLO, C “ASSAN, G BALSAMO, M DE MATTHAIES, R LORENZETTI, S MORINI
COMPARISON OF LINEAR INTERPOLATION AND POWER EXPONENTIAL MODEL IN THE ANALYSIS OF SIMPLIFIED GASTRIC EMPTYING BY SCINTIGRAPKY B P Mullan, D D. Burton, M.R Rank, M Camillen
OSPEDALE NUOVO REGINA MARGHERITA Mayo Clinic and Foundatmn BACKGROUND Pneumaticdilation (PO) is an effective treatmentto relieve dysphagiaand lower esophagealsphincter &ES) obstrucuon in achahwa. Aim ofthe study was to assess modificationsof quality of life (QOL) of patientswith achalasiabefore and a&r PD METHODS- Eighteen consecutivepatientswith achalasia(6 males.12females,mean age 48+/-16, range24-80) treated by PD were prospectwely eoroUed.PD was performed under tluoroscopic control using a 30 mm Rigi& dilator for a standardtiming dilation of 3 minutes Shortform 36 (SF-36) questionmirewas usedto assessQOL before and 3 months following PD RESULTS Mean ,&es (+,-SD) of basaland post treatmentlower esophageal sphmcterpressure decreasedsigrdficantlyfrom 3O+/-9 to 14+/-l mmHg (PC0 M)I) No complicationswere observedand no patientsrequiredsurgery After PD a stgmticam improvementwas obrcrved for 8 out of 9 QOL parameters,namelya) physicaltimctrooing (P=O.O36),b) role limitation dueto physical function (P=&C+O9);c) physical pain (p=O OM)7),d) generalhealth perception (F’=O.OC@S); e) energy Q-0 0063), r) role limitatton due to emotionalproblems(P=O 004); g) mentalhe&h (P=O WI I), h) changein health (P=O 0002). whereasthe parameterregardingsociallimction did not differ before and after PD (P=O4) CONCLUSIONS Our study showedthat PD significartly improved QOL in patientswth achalasiaFunher follow-up is ongoingto evaluatewhether this improvement is sustainedin a long-term period
Background & Aims: Scintigraphy is the gold standard for studvinn aastric emotinn Protocols are not well standardized, hut recent data surest that by reducing the nurhder zf scans the technique becomes more applicable and cost-effective m clinical ore&e Towas et al (Am 1 Gastroenterol2000.95:78-86) suzzest “sine. power expone&ial analysis to calculate gastric half-emptying time (t 112)‘We~ompuedr&dts of power exponential model and linear interpalstion for assessing t I12 and t lag endpoints when gastric emptying is performed using only 4 observation points Patients and methods 37 healthy volunteers underwent scintigraphy for gastric emptying using 99m Tosulphur colloid eggmeal Anterior and posterior gamma-cameraimages were taken at 0, I, 2, 4 hours from the labeled meal ingestion Gastric emptying endpoints were calculated from count ofpercent of isotope remaining in the stomach at 1, 2, 4 hours Both linear interpolation andthe power exponential model [defined as Prop t=(-(kt)^ p), were Prop t is the proportion of retention at time t], were used to calculate t II2 and lag phase Lag phasewas the time at which 5% of the isotope left the stomach. Differences in t l/2 and lag phasev&es calculated with the two techniques were. obtamed for each subject and were Comparedusing paired Wilcoxon test Resuhv Power exponential ‘s goodness of fit for the data points was optimal (median Rsquare 96, IQR 93- 98) t l/2 and lag phasevalues obtamed with linear interpolatioo, power exponential model and differences in these parameters (Deltas) are shown in Table t l/2 results by the two methods arevirtually identical The Deltas for t l/2 calculated with the two methods were significantly lower than the Deltas for the Lag phase @< 001) Conclusions: Power exponential model for calculating gastric half emptying-time from 4 observations can be replicated by simple linear interpolation. For cakulation of lag phase with 4 observations, linear interpolation andpower exponential model differ substantially and, given the goodness of fit tiom the power exponential analysis, the latter method may provide a better estimate oft lag than linear interpolation.
. --
Endpoint Medmn T~o(mms) (IQR) Median Lag phase (tins)
VQR)
Linear interpolation 105 (82 5-142 5) 144 (5.9-24 4)
Power exp model 1047 (84 8-132 5) 24 3 (I9 7-33 6)
Median Deltas
(*QR) 2.8 (0 9-5 9) I25 (9.0-15 7)
2P NON-CARDIAC CHEST PAIN (NCCP) IN PATIENTS WITH NON-EROSIVE REFLUX DISEASE (NERD)EROSIVE DISEASE A INDRIOLO, F NEGRINI, S SIGNORBLLI, M STP.AZABOSCO GASTROENTEROLOGIA
OSPEDAL.1RJUNlTI DI BERGAMO
GestroesophageaIreflox diseaseis presentin many patientswith recurrent chest pain of noncardiac origin In half of thesep&z+ no esophagi&is presentat endascopy(non erosive r&lx disease NERD, We haveinvestigatedthe circadianpattern ofgastro-esophagealretlux in patientswith non cardiac chest pain (NCCP) andNERD as comparedto patientswith NCCP and erosive Methods Seveotysevenconsecutivepatientswith NCCP (45 males,32 females,meanage47 ye. range20-70 yr) were evtiated After clinicalevaluation all padentswere submittedfo upper gastrointestinalendoscopyandesophageal24-hrs pH-monitoring The total tame r&m, upright iie reflox endsupinetime retlox were evaluatedRetlox diseasewes consideredpresemwhen total time percentagewith pH<4 was beyondth 95th percentdefor healthyasymptomaticcontrols (4%) ResultsAmong forrysix patients(6@/.) showingabonormalrefly 24 pts (52%), had NERD, whilst 22 pts (48%) showederosivediseaseAcid retlux was presentin 10% of total time in patientswith erosive disease,ascomparedto 7% in NERD patients In theupright positionabonommlrefhm was presentin 15124patients(62%) in NERD patventsand m 12122patients(54%) with erosive disease@=NS) In the supinepositionabnormalreflux was presentin 17124(71%) NERD patientsandin 18/22(83%) patientswith esophagitis Combinedupright andsupineretlux was presentm 7124(32%) NERD patwds andin I l/22 (50%) patientswith erosive disease@=NS). During the’24 hour ambulatoryesophagealpHmonitoringchest pain was present in 9 (37%) NERD patientsand6 (27%) patientswith erosive disease@=NS). Neither patientswith normalreflux experiencedchest pain during the 24 hour ambulatoryesophagealpH-momtoring ConclusmnPathological acidreflux was presentin 60% of patientsreffered for NCCP, in this group ofpatients, aud reflex in the supinepositionwas the prevalentpattern Inter>y, no sigoificaotditTerenceswere found in reflux time as well ar in the circadian patternbetweenpatleotswith erosive andnon erosivedisease Local factors may be relevant in determiningtheesophagealmucosalresponse
ORO-ESOPHAGEAL TRANSIT AND MOTILlTY DISORDERS IN DYSPHAGIC PATIENTS WITH CONNECTlVE ACUTE DISEASE SIMULTANEOUS MANOMETRIC AND RADIOISOTHOPICAL STUDY G Caliperi,M Pod, E Pustorino, G Luua, 0 Guerrisi. S Pwtorino D~partbnentoClioico Sperimentaledi Medicina eFarmacologia,Universit&di Messina. Background DysphagiaIScommon fmdmg m Connectivetissue disease,oflen associatedwth esophagealperistalsisdisorders, probably, for theu high prevalencein coonective ussue disease. Aim to determine,with a simultaneousmaoometricand radioisothopicalstudy, the dynamics of esophagealcleermg andthe possiblerelationship between transit vdocity of the b&s and manometriccharacteristics of the post-swallowing peristalticsequence Patientsand methods e@t femalepatients,meanage 42,5years (range 19.64 ), with B diagnosisof connectivetissue disease(6 with xleroderma and2 with mixedconnective tissue disease),all complainingwith recurrent chronic dysphasia,5 for solids, 3 for liquids and solids,were enrolled The study was performed onpatientsin supineposition.The traosit of a marked bolosandthe characteristics of the peristaltic sequencewere evaluatedby gamma-cameraand a standardesophagealmanometryrespectively The patientswere invited to swalIow 200 mCi of 99Tc-colloidal solphure,diluted in 10 ml of water, andthento performe 8 dry deglutitions,every I5 seconds, for 2 minutes.Sincethe first deglutition, serial frame by frameimageswere recorded for onesecond eachfor all recondmgperiod. Three areas ofinterest were beenselected proximal, middle anddistalesophagus.In each area the first I5 secondsperiod from the bolos swaUotin8 andthe remaioiog 2 minutes period were separatetyevaluated Results the first contractton followmg the marked b&s deglutition resultedprogressive in 5 oatieotr and simultaneousin 3 oatients The transit WBSslow in 6 oatiemsin the oroximal Lea, in 3 patientsin the middl; area andin 4 patientsin the disti area ’ A percentage> 20% of simultaneouswaves (ranpe37.5.100%) during the seriesof 8 dry deelutitions was detectedm 4 oatieots a slow traosit was detectedin the oraximal a~eain 5 patients,in the middle areain j patientsand in the dwal aream 4 patients ‘No relationslup was foundbetweenthe transit alterationand the severity of the esophagealmotor disorders Conclusion:In patimtr with dvsohaaiaandconnectivetissue diseasethe transit alterations. especiallydm& the early phasesof-emptying seemmore frequentin proximal thanin middle anddistal esophagus,independentlyfrom the presenceof peristaltic alterations In such patientsB possiblemechanismmight becoonectedto elteretiom of the transfer and the ejectionpower of the bolus in esophagus These alterationsmight be responsible,at least pamally,for the dysphagm
A103