STATIONARY ESOPHAGEAL MANOMETRY - Mondino€¦ · LA MANOMETRIA ESOFAGEA Michele Di Stefano U.O....
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1 TECNICHE DIAGNOSTICHE CONVENZIONALI PER LO STUDIO DELLA DISFAGIA LA MANOMETRIA ESOFAGEA Michele Di Stefano U.O. Medicina Interna 1 Fondazione IRCCS Policlinico “S.Matteo” Università di Pavia Pavia STATIONARY ESOPHAGEAL MANOMETRY LES
Transcript of STATIONARY ESOPHAGEAL MANOMETRY - Mondino€¦ · LA MANOMETRIA ESOFAGEA Michele Di Stefano U.O....
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TECNICHE DIAGNOSTICHECONVENZIONALI PER LO STUDIO DELLA DISFAGIA
LA MANOMETRIA ESOFAGEA
Michele Di Stefano
U.O. Medicina Interna 1Fondazione IRCCS Policlinico “S.Matteo”
Università di PaviaPavia
STATIONARY ESOPHAGEAL MANOMETRY
LES
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NORMAL ESOPHAGEAL MANOMETRY
UES
LES
LES
Eso
phag
ealb
ody
ESOPHAGEAL MANOMETRY: INDICATIONS
Evaluation of esophageal motility disorders
Determination of LES prior to pH-impedance studies
Pre-operatively to exclude esophageal motility disorder sif antireflux surgery is considered
Dysphagia
- Primary esophageal motility disorders- Nonspecific esophageal motility disorders- Secondary esophageal motility disorders
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DIFFUSE ESOPHAGEAL SPASM IN PARKINSON’S DISEASE
UES
Stomach
LES
LES
Eso
phag
ealb
ody
UES
Eso
phag
ealb
ody
APERISTALSIS IN PARKINSON’S DISEASE
Pharinx
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NUTCRACKER ESOPHAGUS IN PARKINSON’S DISEASE
UES
Eso
phag
eal b
ody
Pharynx
UES
Stomach
LES
LES
Eso
phag
eal b
ody
DILATED ESOPHAGUS IN PARKINSON’S DISEASE
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STATIONARY ESOPHAGEAL MANOMETRY AND UES
“It is somewhat ironic that, althoughthe upper esophageal sphincter isthe most accessible structure of theesophagus, it is in many ways theleast well-understood ”
Ghosh SK, et al. AJP 2006
UES ESOPHAGEAL MANOMETRY - LIMITS -
UES pressure is influenced by recording methodology
Intraluminal catheters stimulate sphincter contraction
Contractile rate exceeds performance of perfused systems
UES presents an asymmetric structure
UES is characterized by axial movement during swallowing
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LIMITS OF STATIONARY ESOPHAGEAL MANOMETRY:- PHARINGEAL ASYMMETRIC STRUCTURE -
Sears VW Jr, et al. Gastroenterology 1991
0
100
200
300
400
0 1 2 3 4 5 6
mm
Hg
cm above UES
anterior
posterior
right lateral
left lateral
Pharinx6 cm
above UES
Pharinx3 cm
above UES
UES
Anterior/posteriorCatheter orientation
90° rotated
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anterior
posterior
right lateral
LIMITS OF STATIONARY ESOPHAGEAL MANOMETRY:- PHARINGEAL ASYMMETRIC STRUCTURE -
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HIGH-RESOLUTION SOLID-STATE ESOPHAGEAL MANOMETRY
HIGH-RESOLUTION SOLID-STATE ESOPHAGEAL MANOMETRY
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SOLID-STATE HIGH-RESOLUTION MANOMETRY
Assenza di peristalsi Onde simultaneea bassa pressione
Onde simultaneead elevata pressione
SOLID-STATE HIGH-RESOLUTION MANOMETRY
Spasmo Esofageo Diffuso
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SOLID-STATE HIGH-RESOLUTION MANOMETRY
Nutcracker esophagus Jackhammer esophagus
SOLID-STATE HIGH-RESOLUTION MANOMETRY
Sclerodermic esophagus
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SOLID-STATE HIGH-RESOLUTION UES MANOMETRY
Pharynx
CompleteSphincter Relaxation
IncompleteSphincter Relaxation
UES HIGH RESOLUTION MANOMETRY AND EMG
UESHRM
Normal Relaxation Incomplete Relaxation
CFEMG
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THE ADDED VALUE OF INTRALUMINAL IMPEDANCEIN THE STUDY OF DEGLUTITION
Non Acidic Reflux EpisodeP
roxi
mal
es
opha
gus
esophaguspH
IMP
ED
AN
CE
Dis
tal
esop
hagu
s
stomach
HIGH RESOLUTION IMPEDANCE MANOMETRY
Pharynx
UES
LES
Eso
phag
eal
Bod
y
UES
Eso
phag
eal
Bod
y
LES
IntraluminalImpedance
IntraluminalPressure
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HIGH RESOLUTION IMPEDANCE MANOMETRY AND GERD
Pharynx
UES
LES
Eso
phag
eal
Bod
y
UES
Bod
y
LES
HR IMPEDANCE MANOMETRY AND PHARYNGEAL TRANSIT
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HR IMPEDANCE MANOMETRY AND PHARYNGEAL TRANSIT
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