P. Lawlor

Electrogastrography: a non-invasive measurement of gastric function.

BackgroundElectrogastrography (EGG) is the non-invasive measurement of gastric electrical activity. With the development of modern technology, improved recording and automated analysis, it is a reliable and accurate technique for the measurement of gastric myoelectrical activity providing information about the frequency and regularity of the gastric slow wave.AimThe aim of this report is to evaluate its role in clinical practice.MethodsThe literature is reviewed and its role investigated.ResultsEGG has been successfully used in the investigation of gastroparesis, non-ulcer dyspepsia (NUD), gastric emptying (GE) disorders and diabetes mellitus (DM). EGG also provides an insight into the effect of medications on gastric function, e.g. edrophonium, cisapride, erythromycin and proton-pump inhibitors (PPI).ConclusionsEGG has a developing role in the assessment of gastric dysfunction and on the effect of medical treatment. The effect of surgery and anaesthesia on gastric myoelectric activity is less clear.

A new technique for measuring lower oesophageal sphincter competence in patients

SummaryOesophageal sphincter measurements were carried out on 80 patients using the stationary pull through technique; Normals (n=21), Nutcracker (n=12), Refluxers (n=21), and Barrett’s (n=26). Sphincter pressure (LOSP), abdominal length of sphincter, and overall sphincter length were measured. The Sphincter Function Index (SFI) was calculated as the product of sphincter pressure and percentage sphincter length (AL) exposed to abdominal pressure. Patients also had routine endoscopy and 24 hour pHmetry. SFI values discriminated between all four groups. LOSP was significantly different for Barrett’s (p<0.01) and Nutcracker (p<0.01) compared to normals. AL was significant for Refluxers (p<0.001) and Barrett’s (p<0.001) compared to normals. SFI gives better discrimination than LOSP or AL alone and may be useful in evaluating the response to treatment.

Oesophageal motility and digestion of cream liqueurs in combination with common alcohol mixers.

When acidic mixers are added to cream liqueur curdling occurs. Oesophageal motility was studied in normal volunteers during ingestion of this mixture and the effect of combining with gastric juice was assessed in a simulated physiological environment. Twenty-four h ambulatory manometry and pH (n=22) and gastric studies (n=7) were carried out. There was no detrimental effect on oesophageal motility. The precipitation is rapidly broken down by the digestive process in the stomach.

Oesophageal manometry: 10-year audit from a specialist centre, and early experience with high-resolution manometry

BackgroundManometry is the gold standard investigation of innate or acquired motility disorders in the oesophagus. New technology in the form of high-resolution manometry (HRM) may supplant traditional water-perfused manometry and enhance standardisation of manometric interpretation and reporting. This study reports on a 10-year experience of 5,184 consecutive patients using the traditional methods, and an early experience with HRM.ResultsOf 5,184 patients assessed, 4,509 (87xa0%) had both pH and manometry and 675 (13xa0%) had manometry only. 3,523 (78xa0%) of the pH /manometry group had normal motility, 635 (14xa0%) showed ineffective motility (IM), 213 (5xa0%) a non-specific motility disturbance (NSMD), 42 (0.9xa0%) achalasia, 58 (1.3xa0%) nutcracker oesophagus, 22 (0.5xa0%) hypertensive LOS (HLOS), 8 (0.2xa0%) diffuse oesophageal spasm (DOS) and 8 (0.2 xa0%) had scleroderma. For those referred solely for manometry only, 324 (48xa0%) had normal motility, 72 (11xa0%) IM, 51 (8xa0%) NSMD, 175 (26xa0%) achalasia, 16 (2xa0%) nutcracker oesophagus, 32 (5xa0%) HLOS, 1 (0.1xa0%) DOS and 4 (0.6xa0%) had scleroderma. 92 patients to date have been studied with HRM, with enhanced definition of lower oesophageal sphincter (LOS) function.ConclusionFor patients referred for reflux related symptoms, motility disorders are present in 22xa0% of the cases. Conversely, of the patients referred for dysphagia, motility disturbances are detected in 52xa0% of the cases sent for manometry. Our initial experience shows that HRM technology is adding a valuable dimension and clearer understanding of motility patterns in the dysphagic patient.