Tesi di laurea magistrale LM6
Ruolo dei Test provocativi a basso ed alto volume durante Manometria Esofagea ad Alta risoluzione in pazienti affetti da JackHammer esophagus: studio prospettico
RICERCA TRASLAZIONALE E DELLE NUOVE TECNOLOGIE IN MEDICINA E CHIRURGIA
Corso di studi
MEDICINA E CHIRURGIA
relatore Prof. de Bortoli, Nicola
- manometria esofagea alta risoluzione
- Jackhammer esophagus
Data inizio appello
Data di rilascio
Introduction. Jackhammer esophagus (JE) is a hypercontractile disorder, the pathogenesis of which is incompletely understood. Multiple rapid swallows (MRS) and rapid drink challenge (RDC) are complementary tests used during high resolution manometry (HRM) that evaluate inhibitory and excitatory neuromuscular function and latent obstruction respectively.<br>Aims & Methods. Our aim was to evaluate esophageal pathophysiology using MRS and RDC in 83 JE patients (28 males; 63; 54‐70 years). Twenty one healthy subjects (11 males; 28; 26-30 years) were used as a control group. All patients underwent solid state HRM with ten 5 ml single swallows (SS) and one to three 10 ml MRS; 34 patients also underwent RDC. Data are shown as median‐IQ range.<br>Results. Abnormal motor inhibition was noted during at least one MRS in 48% of JE vs 29% of controls (p=0.29). Mean DCI after MRS was significantly lower than after SS [6028 (3678-9267) mmHg.cm.s vs 7514 (6238-9197) mmHg.cm.s, p=0.02], as was highest DCI (p<0.0001). Consequently, 66% of JE patients had no contraction reserve. At least one variable of obstruction during RDC was outside the normal range in 74% of JE. Both highest DCI after SS and pressure gradient across the esophagogastric junction during RDC were higher in patients with dysphagia vs those without (p=0.04 and 0.01 respectively).<br>Conclusions. Our data suggest altered neural control in JE patients with heterogeneity in inhibitory function. Furthermore, some patients had latent esophagogastric junction obstruction during RDC which correlated with the presence of dysphagia.
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