A. Anggiansah

Normative values and inter-observer agreement for liquid and solid bolus swallows in upright and supine positions as assessed by esophageal high-resolution manometry.

Backgroundu2002 High‐resolution manometry (HRM) with spatiotemporal representation of pressure data is a recent advance in esophageal measurement. At present, normal values are available for 5u2003mL water swallows in the supine position. This study provides reference values for liquid and solid bolus swallows in the upright seated and supine positions.

Failure to respond to physiologic challenge characterizes esophageal motility in erosive gastro-esophageal reflux disease

Backgroundu2002 Non‐specific esophageal dysmotility with impaired clearance is often present in patients with gastro‐esophageal reflux disease (GERD), especially those with erosive disease; however the physio‐mechanic basis of esophageal dysfunction is not well defined.

Assessment of esophageal dysfunction and symptoms during and after a standardized test meal: development and clinical validation of a new methodology utilizing high-resolution manometry.

In the absence of major dysmotility, esophageal manometry with water swallows rarely explains the causes of esophageal symptoms and disease. This methodology development study assessed esophageal function and symptoms during a test meal in patients with reflux symptoms and asymptomatic controls. The impact of this approach on manometric diagnosis and clinical outcome was reviewed.

Prolonged, wireless pH‐studies have a high diagnostic yield in patients with reflux symptoms and negative 24‐h catheter‐based pH‐studies

Backgroundu2002 Catheter‐based esophageal pH‐monitoring is used to evaluate patients with suspected gastro‐esophageal reflux disease (GERD); however false‐negative results may occur due to poor tolerance of the catheter with reduced oral intake and activity, or high day‐to‐day variation in reflux and symptom events. We assessed diagnostic yield and clinical impact of prolonged, wireless pH‐monitoring in patients with negative results from 24‐h catheter‐based studies and ongoing symptoms.

The effects of obesity on oesophageal function, acid exposure and the symptoms of gastro‐oesophageal reflux disease

Obese patients have an increased risk of gastro‐oesophageal reflux disease; however, the mechanism underlying this association is uncertain.

Sildenafil relieves symptoms and normalizes motility in patients with oesophageal spasm: a report of two cases

Abstractu2002 Oesophageal spasm presents with dysphagia and chest pain. Current treatments are limited by poor efficacy and side effects. Studies in health and oesophageal dysmotility show that sildenafil reduces peristaltic pressure and velocity; however the clinical efficacy and tolerability in symptomatic oesophageal spasm remains uncertain. We provided open‐label sildenafil treatment to two patients with severe, treatment resistant symptoms associated with oesophageal spasm. The effects of sildenafil on oesophageal function and symptoms were documented by high resolution manometry (HRM). Patients were followed up to assess the efficacy of maintenance treatment with sildenafil b.i.d. HRM revealed focal and diffuse spasm in the smooth muscle oesophagus that were associated with symptoms in both cases, especially on swallowing solids. Lower oesophageal sphincter function was normal. A therapeutic trial of 25–50u2003mg sildenafil suppressed oesophageal contraction almost completely for water swallows; however effective, coordinated peristalsis returned with reduced frequency of spasm for solid swallows. Dysphagia and chest pain resolved during the therapeutic trial and efficacy was maintained on maintenance treatment with 25–50u2003mg sildenafil b.i.d. without troublesome side effects. This report shows that sildenafil can improve oesophageal function and relieve dysphagia and chest pain in patients with oesophageal spasm in whom other treatments have failed.

Measurement of esophago-gastric junction cross-sectional area and distensibility by an endolumenal functional lumen imaging probe for the diagnosis of gastro-esophageal reflux disease

Measurement of esophago‐gastric junction (EGJ) cross‐sectional area (CSA) and distensibility by an Endolumenal Functional Lumen Imaging Probe (EndoFLIP®) may distinguish between gastro‐esophageal reflux disease (GERD) patients and healthy volunteers (HV). We aimed to assess the agreement of EndoFLIP® measurements with clinical and physiologic diagnosis of GERD.

Post‐prandial reflux suppression by a raft‐forming alginate (Gaviscon Advance) compared to a simple antacid documented by magnetic resonance imaging and pH‐impedance monitoring: mechanistic assessment in healthy volunteers and randomised, controlled, double‐blind study in reflux patients

Alginates form a raft above the gastric contents, which may suppress gastro‐oesophageal reflux; however, inconsistent effects have been reported in mechanistic and clinical studies.

Patient acceptance and clinical impact of Bravo monitoring in patients with previous failed catheter‐based studies

Backgroundu2002 Standard pH monitoring is performed over 24u2003h with a naso‐oesophageal catheter (C‐pH). Limitations include naso‐pharyngeal discomfort, nausea and social embarrassment resulting in reduced reflux‐provoking activities. Recently a catheter‐free pH‐monitoring technique has become available. The tolerability and diagnostic yield of this system in patients who failed standard monitoring remain unknown.

Upper esophageal sphincter and esophageal motility in patients with chronic cough and reflux: assessment by high‐resolution manometry

The pathophysiology of chronic cough and its association with dsymotility and laryngopharyngeal reflux remains unclear. This study applied high-resolution manometry (HRM) to obtain a detailed evaluation of pharyngeal and esophageal motility in chronic cough patients with and without a positive reflux-cough symptom association probability (SAP). Retrospective analysis of 66 consecutive patients referred for investigation of chronic cough was performed. Thirty-four (52%) were eligible for inclusion (age 55 [19-77], 62% female). HRM (ManoScan 360, Given/Sierra Scientific Instruments, Mountain View, CA) with 10 water swallows was performed followed by a 24-hour ambulatory pH monitoring. Of this group, 21 (62%) patients had negative reflux-cough SAP (group A) and 13 (38%) had positive SAP (group B). Results from 23 healthy controls were available for comparison (group C). Detailed analysis revealed considerable heterogeneity. A small number of patients had pathological upper esophageal sphincter (UES) function (n=9) or esophageal dysmotility (n=1). The overall baseline UES pressure was similar, but average UES residual pressure was higher in groups A and B than in control group C (-0.2 and -0.8mmHg vs. -5.4mmHg; P<0.018 and P<0.005). The percentage of primary peristaltic contractions was lower in group B than in groups A and C (56% vs. 79% and 87%; P=0.03 and P<0.002). Additionally, intrabolus pressure at the lower esophageal sphincter was higher in group B than in group C (15.5 vs. 8.9; P=0.024). HRM revealed changes to UES and esophageal motility in patients with chronic cough that are associated with impaired bolus clearance. These changes were most marked in group B patients with a positive reflux-cough symptom association.