- Email: [email protected]
or botulinum toxin injection) affect the results of laparoscopic heller myotomy?
Motility
107
105 sPoNTANBous RELAXATIONS Basil&o
JNTERNAL AN& AND FECAL, INCONTINENCE
G, Mularczyk
SPHINCTER
A, Marino B.
U.O. di Gzutroenterologia, Dipmtimento di Scienze dell’Universiti IRCCS-Ospedale Maggiore di Milano.
Mediche
Backgroond: More iiequent internal anal sphincter relaxations were suggested to cause fecal inwntinence in patients with reduced anal pressures, without the prior exclusion of structural or neural damage to the spbimter. Aim To assess the prevalence of an increased firqlency of internal anal spbblcw relaxations in patients with fecal inwntinencc but without structural or timctional sphincter damage. Methods: Anal endosonography was performed in 125 consecutive fecally incontinent patients (97 females, mean ag&D: 54f13 years), and anorcctal manometry and pelvic floor electromyography in those with an intact sphincter. If a routine 10 minutes nxwding detected any spontsneoos internal anal sphincter ralaxation, it was followed by a l-bow recording of resting anal pressmw. The results were compared with those of internal controls. Data in contmls are mean&SD. Resti Sphincter lesions were found in 85% of the patients. Three of the remahhg cases (prevalence 2.4%; all males aged 20-38 years) had an intact internal and sphiiter, normal mean resting ad pressm (range 50-69 mmHg vs 79-121 mmHg in 11 healthy subjects aged 19-58 years) and normal pelvic floor electromyogmphy, but more frequent and longer l&g spontaneous internal anal sphincter relaxations than in conimls (rage 6-IO/hour YS 1.3f1.3/hoor and 55-98 seconds vs 32i7 seconds in eight healthy subjects aged 21-26 years). Conclusions: Increased f&quency and duration of spontaneous internal anal sphincw relaxations may be a me cause of fecal incontinence in patients with an intact sphincter and normal resting anal pressure. Prolonged recording of resting anal pressure is advisable to detect such patients.
CONNECTIVE TISSUE DISEASE ORAL AND PHARYNGEAL SWALLOWING AEtNORMALmES SlLVIA TORRICO. FORTUNE’E IRENE HABIB Diputimento di ScienceCliniche,UttiversitaLa Sapienza,Rome Uttiversit~ ‘La Sapietua’ Patientswith wmttective tissue diseasemay complainaf swallowing disorders. However the kquency andtype of orophatptgeal involvement in such disordetx is poorly tmdetstcad(I). Aims of this sbtdy were to detenttinethe relative frequency of abttamalities of the oral and pbatyngeal phasesof the swallowittg process as assessedby videoflttomscopy (VFS)and the relationshipwith esophagealttmtor abrtotmalities.Patientsandmethod. 52 patients(9M, median age54yrs, range 25. 6%) with a diagnosisof connectivetissue disease(sclemdermaor CREST), complaining of GER symptoms(30/52:58%) and/ordysphagia(35/52: 67%), 20 for solids, 4 for liquids and 1I for both, were enrdkd in the study. Cough andchoking were repottedby 23% and 19%of patients, respectively. VFS wes petfomted with the patientin the lying supine,prone oblique and in the uptight positton,whtle swallowing 5ml of barium, itt onebolus at time. The oral andpbatyttgeal phaseswere studied in the sit6ng position, in the latexalandantem-posterior pmjation Results. Impeitmetttaftbe oral ettdpharyngeal swallowingphaseswas detectedin 27/52pattcnts (51%). 10 patientsshowedabttomtalitiesofthe whole swallowing process. 17/52patients (32%.)showed abnormalitiesof the oral phase:reducedrangeofmovements ofthe tongue(IO), tmtgtteresidue (7), piecemealdeglutition (5), inability to managethe balus (4), leakagein the pharynx before et after the actualswallow (9), fall of matetial in the lateralot anterior sulci (4). 20/52 patients(38%) showedphatyngealmotor alterations:tynoplteryngealregurgitation(6), ittccmpleieepiglottis tilt (4), pcdttg in the vallaulae (17) andpyriform sinuses(IO), intmdegltttihvepatetmtion (4). aspiration(I), esophago-pbatyttgealreflex (1 I). In all 52 patientstherewere esophagealmet01 disordm es assessedby VFS. There was M relationshipbehveenom-pltaryngealimpairmentand severit of esophagealttwtcn disorders. C0ttclusiotts.Impaimtettt of the oral and/or phatyngeal phasesof swallowing is detectedin up to 51% of patientswith catttective tissue disease complainingof dyspltagia and/orGER symptoms. IQ thesepatientsompberyngealittvolvement contributeto dysphagiaandrespiratoty symptoms (31%). VFS may help d&ing subgroupsof patientswho may eventuallybenefit from rehabilitation.I. A Montesi et al. Dysphagia 1991; 6~219.23
106 GASTRICANTRAL DISTENSlONAND SYMPTOMSEVALUATIONlND”CED BY A WATERLOAD TESTIN HEALTHY SUBJECTSAND PATIENTSWITH FuNcnONAL
DYSPEPSIA D. Pinto,c. Toseni,M.G. Matts,Y. Stanghellini,
Dept. oflntentd
Medicine;
University
ofBologna,
B. Sdviob, Italy.
R. Cmbtddesi
S.orseln
bqmkedgastricdistensionandebwtmslhiesof gastricenbumsizehavebeat detnmtstteted in psdmtswith tiutcmttsldyspcpsis(FD). WaterLandTestsM cmsidued simplemctbodsto mducc acutegssnic distension,but thenWmsbip betwcmsymptomssod thissbnmmsbtyis unclear Aim: UIevebmtctie gestic et&mldistatsionendsym@mttsinducedby e WeterLoadT& in patientswith timctiemldyspepsi (FD) em5be&by cettfmla(HC). Patientsettdmahods:e&rag ovettd& list, sixteenHC (7 males,3213ye,BMI=24+l kght% m+SEM)and20matched patientspith PD diagnosedecwding theP.eme2 Cntetie(8m&s. 33s yr, BMI=23+1kgicm2), weresskedto drbtk l3sbmNptedly,St zw cc smps,ttmt.sprLrhg ttdned watetatm tempemq adlibitum(Mawek ml). Gastricantal aa (AA; cm2)wes evektetedby ee ul~m~bic m&d be&e thetest(“3). et timeofMarvel (tMaxv,,l) endet 15;minbttewais thaeti utttil thesectionMB al theardmmtetumd te beselvalues.An emptyingrate(ER= MaxvaVtimeneededLorestmebeselbteanti size)ws calculated.Satiety,cpigastricpain,nausea andepigsstticfdbtess weredueted (104mm visualattdegttesdca, VAS) at t0,tbkvol, 130 andt6O Resubs:FDp.tientspresetttedlewcrwetetittgestiee(1265&#,5,6,7;54ml; mBi#6l617:sBM),~sdAAattMarvol(28.48r#61617;1,2~)imdlowsrER(13~#616l7,1 m~min)comparcdbAC(lb93&~1617;85 ml, 17.81 em2.19I617;1mVrmn; P
MAY A PREVIOUS TREATMENT (PNEUMATIC DILATION AND/OR BOTULINUM TOXIN INJECTION) AFFECT THE RESULTS OF LAPAROSCOPIC HELLER MYOTOMY? G. Pot-tale,G. Zattittotto.M. Costetttini.D. Molena. B. Gttocato. C. Rizzetto. M. Costantino.A. Capuzm, E. Ancotta. Departmentof Medical and SurgicalSciences,Clinica Chintrgica IV, Padova Chtca Ghinqica IV Backgmttnd andaim. Despite pnettmaticdilatation andintmspbinctetic b@tdittttmtoxin (&tax) injection can be usedaainitial treatmentfor acbalesin,lapamswpic Hella tnyc4mtty npnsmtts the tt-eatmetttof choice in this oetimts. Aim of the studv was to assessthe &ects af tious ettdoempictreatmenton e&ageal myotomy. M&als end methods.Fmm Jatuaty 1992and May 2001 we studied 142 patients(82 M ad 60 F, median age42 yrs, range: 1l-80) witb acbelasia thatunderwent a lapamecopicHe&x tttyotmny: 117(65 M and52 F, median age42.1 yrs, ratgel l-80) didn’t have any previous lreakaent Gtuttp A), 14(9 M and 5 F, median age43.5 years, rattge:lS-73) were pretwed with pttemuic b&otJ dil&iOtt (mediatt2 dilata&sfpatiettt, range l-8) (Gmup B) and 11 (8 M and 3 F, median age49.5 yeare.range: 38-73) tmdetwettt bdthtm toxin ittiection (7 ottb botox, 4 both batox and dilatatiotts~(Gmtm 0. Results..Were were seveninttno~aative &&diott of the esophagealmttwsa: 6 itt’&ttp A (i wet< sutured lapamswpically, two weded for conversion, one was treatedmnservaiively) end 1 itt grxp C (sutured lapamscnpically). There was 110surgical tmntality Cattplete relidof dynph& Was achievedin 105/l 17(89.7%) group A 1304 (92.8%) group B, 9/l I (81%) group C pts (meat follow-up 26 months). 12 patientsof gmttP A, 1 patientof group B attd 2 patients of group C neededfor 2-4 cotnplementeryettdoscopic dilatation: dyspbagiawas relieved in 12/l 5 of these patients. I patient of gmup A and 1patient of grmtpB required a new opcmtion. I patientof gmup A refwad any tinthn treatmmt. C~ttclusions.Prmpaetive ettdesmpic treatmentis not a risk factor for intmoperativetttttceselperforatiats and doesnot affect the outcome of lapamswpic Heller myototlty.
1“C-0A BT 1S-albttres 1 1“C-OA BT ) S-@lets 1 11/2(min) 1 224f72* I 117M2 / rO.54~~ 1 192M9* 1 123&24 1t=O.670 k(min) 1 134f33’ 1 12fl5 j PO.06 1 128i33’ I 23t18 I~0.87ac m;tSD; *p
tMaxvol Symptom (mm) satiety Fullness Nausea P&l
130
HC
DF
HC
DF
55 52 14 5
75’ 70’ 44. 20’
31 21 5 2
43 38’ 26. 11’
VAS (mm) /Mawof
too
HC
DF 18 11
5 1
29 20 22’ IO’
(ml) x 1000: ‘pG.05 vs HC (Mann-Whineyfest)
A33
107
105 sPoNTANBous RELAXATIONS Basil&o
JNTERNAL AN& AND FECAL, INCONTINENCE
G, Mularczyk
SPHINCTER
A, Marino B.
U.O. di Gzutroenterologia, Dipmtimento di Scienze dell’Universiti IRCCS-Ospedale Maggiore di Milano.
Mediche
Backgroond: More iiequent internal anal sphincter relaxations were suggested to cause fecal inwntinence in patients with reduced anal pressures, without the prior exclusion of structural or neural damage to the spbimter. Aim To assess the prevalence of an increased firqlency of internal anal spbblcw relaxations in patients with fecal inwntinencc but without structural or timctional sphincter damage. Methods: Anal endosonography was performed in 125 consecutive fecally incontinent patients (97 females, mean ag&D: 54f13 years), and anorcctal manometry and pelvic floor electromyography in those with an intact sphincter. If a routine 10 minutes nxwding detected any spontsneoos internal anal sphincter ralaxation, it was followed by a l-bow recording of resting anal pressmw. The results were compared with those of internal controls. Data in contmls are mean&SD. Resti Sphincter lesions were found in 85% of the patients. Three of the remahhg cases (prevalence 2.4%; all males aged 20-38 years) had an intact internal and sphiiter, normal mean resting ad pressm (range 50-69 mmHg vs 79-121 mmHg in 11 healthy subjects aged 19-58 years) and normal pelvic floor electromyogmphy, but more frequent and longer l&g spontaneous internal anal sphincter relaxations than in conimls (rage 6-IO/hour YS 1.3f1.3/hoor and 55-98 seconds vs 32i7 seconds in eight healthy subjects aged 21-26 years). Conclusions: Increased f&quency and duration of spontaneous internal anal sphincw relaxations may be a me cause of fecal incontinence in patients with an intact sphincter and normal resting anal pressure. Prolonged recording of resting anal pressure is advisable to detect such patients.
CONNECTIVE TISSUE DISEASE ORAL AND PHARYNGEAL SWALLOWING AEtNORMALmES SlLVIA TORRICO. FORTUNE’E IRENE HABIB Diputimento di ScienceCliniche,UttiversitaLa Sapienza,Rome Uttiversit~ ‘La Sapietua’ Patientswith wmttective tissue diseasemay complainaf swallowing disorders. However the kquency andtype of orophatptgeal involvement in such disordetx is poorly tmdetstcad(I). Aims of this sbtdy were to detenttinethe relative frequency of abttamalities of the oral and pbatyngeal phasesof the swallowittg process as assessedby videoflttomscopy (VFS)and the relationshipwith esophagealttmtor abrtotmalities.Patientsandmethod. 52 patients(9M, median age54yrs, range 25. 6%) with a diagnosisof connectivetissue disease(sclemdermaor CREST), complaining of GER symptoms(30/52:58%) and/ordysphagia(35/52: 67%), 20 for solids, 4 for liquids and 1I for both, were enrdkd in the study. Cough andchoking were repottedby 23% and 19%of patients, respectively. VFS wes petfomted with the patientin the lying supine,prone oblique and in the uptight positton,whtle swallowing 5ml of barium, itt onebolus at time. The oral andpbatyttgeal phaseswere studied in the sit6ng position, in the latexalandantem-posterior pmjation Results. Impeitmetttaftbe oral ettdpharyngeal swallowingphaseswas detectedin 27/52pattcnts (51%). 10 patientsshowedabttomtalitiesofthe whole swallowing process. 17/52patients (32%.)showed abnormalitiesof the oral phase:reducedrangeofmovements ofthe tongue(IO), tmtgtteresidue (7), piecemealdeglutition (5), inability to managethe balus (4), leakagein the pharynx before et after the actualswallow (9), fall of matetial in the lateralot anterior sulci (4). 20/52 patients(38%) showedphatyngealmotor alterations:tynoplteryngealregurgitation(6), ittccmpleieepiglottis tilt (4), pcdttg in the vallaulae (17) andpyriform sinuses(IO), intmdegltttihvepatetmtion (4). aspiration(I), esophago-pbatyttgealreflex (1 I). In all 52 patientstherewere esophagealmet01 disordm es assessedby VFS. There was M relationshipbehveenom-pltaryngealimpairmentand severit of esophagealttwtcn disorders. C0ttclusiotts.Impaimtettt of the oral and/or phatyngeal phasesof swallowing is detectedin up to 51% of patientswith catttective tissue disease complainingof dyspltagia and/orGER symptoms. IQ thesepatientsompberyngealittvolvement contributeto dysphagiaandrespiratoty symptoms (31%). VFS may help d&ing subgroupsof patientswho may eventuallybenefit from rehabilitation.I. A Montesi et al. Dysphagia 1991; 6~219.23
106 GASTRICANTRAL DISTENSlONAND SYMPTOMSEVALUATIONlND”CED BY A WATERLOAD TESTIN HEALTHY SUBJECTSAND PATIENTSWITH FuNcnONAL
DYSPEPSIA D. Pinto,c. Toseni,M.G. Matts,Y. Stanghellini,
Dept. oflntentd
Medicine;
University
ofBologna,
B. Sdviob, Italy.
R. Cmbtddesi
S.orseln
bqmkedgastricdistensionandebwtmslhiesof gastricenbumsizehavebeat detnmtstteted in psdmtswith tiutcmttsldyspcpsis(FD). WaterLandTestsM cmsidued simplemctbodsto mducc acutegssnic distension,but thenWmsbip betwcmsymptomssod thissbnmmsbtyis unclear Aim: UIevebmtctie gestic et&mldistatsionendsym@mttsinducedby e WeterLoadT& in patientswith timctiemldyspepsi (FD) em5be&by cettfmla(HC). Patientsettdmahods:e&rag ovettd& list, sixteenHC (7 males,3213ye,BMI=24+l kght% m+SEM)and20matched patientspith PD diagnosedecwding theP.eme2 Cntetie(8m&s. 33s yr, BMI=23+1kgicm2), weresskedto drbtk l3sbmNptedly,St zw cc smps,ttmt.sprLrhg ttdned watetatm tempemq adlibitum(Mawek ml). Gastricantal aa (AA; cm2)wes evektetedby ee ul~m~bic m&d be&e thetest(“3). et timeofMarvel (tMaxv,,l) endet 15;minbttewais thaeti utttil thesectionMB al theardmmtetumd te beselvalues.An emptyingrate(ER= MaxvaVtimeneededLorestmebeselbteanti size)ws calculated.Satiety,cpigastricpain,nausea andepigsstticfdbtess weredueted (104mm visualattdegttesdca, VAS) at t0,tbkvol, 130 andt6O Resubs:FDp.tientspresetttedlewcrwetetittgestiee(1265&#,5,6,7;54ml; mBi#6l617:sBM),~sdAAattMarvol(28.48r#61617;1,2~)imdlowsrER(13~#616l7,1 m~min)comparcdbAC(lb93&~1617;85 ml, 17.81 em2.19I617;1mVrmn; P
MAY A PREVIOUS TREATMENT (PNEUMATIC DILATION AND/OR BOTULINUM TOXIN INJECTION) AFFECT THE RESULTS OF LAPAROSCOPIC HELLER MYOTOMY? G. Pot-tale,G. Zattittotto.M. Costetttini.D. Molena. B. Gttocato. C. Rizzetto. M. Costantino.A. Capuzm, E. Ancotta. Departmentof Medical and SurgicalSciences,Clinica Chintrgica IV, Padova Chtca Ghinqica IV Backgmttnd andaim. Despite pnettmaticdilatation andintmspbinctetic b@tdittttmtoxin (&tax) injection can be usedaainitial treatmentfor acbalesin,lapamswpic Hella tnyc4mtty npnsmtts the tt-eatmetttof choice in this oetimts. Aim of the studv was to assessthe &ects af tious ettdoempictreatmenton e&ageal myotomy. M&als end methods.Fmm Jatuaty 1992and May 2001 we studied 142 patients(82 M ad 60 F, median age42 yrs, range: 1l-80) witb acbelasia thatunderwent a lapamecopicHe&x tttyotmny: 117(65 M and52 F, median age42.1 yrs, ratgel l-80) didn’t have any previous lreakaent Gtuttp A), 14(9 M and 5 F, median age43.5 years, rattge:lS-73) were pretwed with pttemuic b&otJ dil&iOtt (mediatt2 dilata&sfpatiettt, range l-8) (Gmup B) and 11 (8 M and 3 F, median age49.5 yeare.range: 38-73) tmdetwettt bdthtm toxin ittiection (7 ottb botox, 4 both batox and dilatatiotts~(Gmtm 0. Results..Were were seveninttno~aative &&diott of the esophagealmttwsa: 6 itt’&ttp A (i wet< sutured lapamswpically, two weded for conversion, one was treatedmnservaiively) end 1 itt grxp C (sutured lapamscnpically). There was 110surgical tmntality Cattplete relidof dynph& Was achievedin 105/l 17(89.7%) group A 1304 (92.8%) group B, 9/l I (81%) group C pts (meat follow-up 26 months). 12 patientsof gmttP A, 1 patientof group B attd 2 patients of group C neededfor 2-4 cotnplementeryettdoscopic dilatation: dyspbagiawas relieved in 12/l 5 of these patients. I patient of gmup A and 1patient of grmtpB required a new opcmtion. I patientof gmup A refwad any tinthn treatmmt. C~ttclusions.Prmpaetive ettdesmpic treatmentis not a risk factor for intmoperativetttttceselperforatiats and doesnot affect the outcome of lapamswpic Heller myototlty.
1“C-0A BT 1S-albttres 1 1“C-OA BT ) S-@lets 1 11/2(min) 1 224f72* I 117M2 / rO.54~~ 1 192M9* 1 123&24 1t=O.670 k(min) 1 134f33’ 1 12fl5 j PO.06 1 128i33’ I 23t18 I~0.87ac m;tSD; *p
tMaxvol Symptom (mm) satiety Fullness Nausea P&l
130
HC
DF
HC
DF
55 52 14 5
75’ 70’ 44. 20’
31 21 5 2
43 38’ 26. 11’
VAS (mm) /Mawof
too
HC
DF 18 11
5 1
29 20 22’ IO’
(ml) x 1000: ‘pG.05 vs HC (Mann-Whineyfest)
A33