Color Atlas of High Resolution Manometry

by Conklin, Jeffrey, M.D.; Pimentel, Mark, M.D.; Soffer, Edy, M.D.

• ISBN13: 9780387882925
• ISBN10: 0387882928
• Edition: 1st
• Format: Hardcover
• Copyright: 2009-04-30
• Publisher: Springer Verlag

Summary

While reflux disease, achalasia, esophageal spasm, gastroparesis and IBS include some of the most common disorders in all disease categories, the understanding of their pathophysiology has remained elusive. The field of clinical gastrointestinal motility has for decades relied on the measurement of intestinal movements for diagnosis and management of these difficult and enigmatic disorders of gut function. Although computers have increased the speed with which we can measure the movements of the gut, the devices to measure this movement have not changed in over 20 years. In the last 2 years, a new technologic breakthrough has taken place in the measurement of intestinal movement. The technology is called high resolution manometry. Rather than the old 4 and 8 channels systems of measuring pressure, high resolution employs 36 closely spaced solid state pressure transducers. By using this technology, the resolution of gut motor activity is incredible. This allows for better ways of viewing motility using color as pressure. This technology makes for beautiful images of gut motility that we have never seen before. We have made diagnoses that would never have been appreciated with the old technology. High resolution manometry is taking over conventional manometry worldwide and represents a dramatic leap in a long time stagnant area.

Author Biography

Jeffrey Conklin, MD, is Medical Director, Esophageal Center at Cedars-Sinai Medical Center, Los Angeles, California. Mark Pimentel, MD, is Director, GI Motility Program, Cedars-Sinai Medical Center, Los Angeles, California. Edy Soffer, MD, is Co-Director, GI Motility Program, Cedars-Sinai Medical Center, Los Angeles, California.

Table of Contents

Acknowledgement	p. vii
About the Authors	p. ix
Introduction to High-Resolution Manometry	p. 1
High-Resolution Manometry: How Does It Work?	p. 2
Esophageal Manometry	p. 11
Normal High-Resolution Esophageal Manometry	p. 12
Respiratory Variations in the Body of the Esophagus	p. 12
Transition Zone	p. 13
Pressure Inversion Point	p. 15
Lower Esophageal Sphincter	p. 15
Normal Bolus Pressure	p. 16
Peristalsis	p. 17
Gastric Pressures	p. 17
Abnormal High-Resolution Esophageal Manometry	p. 17
Achalasia	p. 17
Diffuse Esophageal Spasm	p. 25
Nutcracker Esophagus	p. 32
Hiatal Hernia	p. 32
Gastroesophageal Reflux Disease and Lower Esophageal Sphincter	p. 32
Scleroderma	p. 32
Ineffective Esophageal Motility	p. 32
Cricopharyngeal Bar	p. 40
Other Esophageal Observations with High-Resolution Manometry	p. 40
Troubleshooting in High-Resolution Manometry of the Esophagus	p. 51
Folded Catheter	p. 51
Failed Sensor Bank	p. 51
Air in the Sheath	p. 55
Gastric/Small Bowel Manometry	p. 59
Normal Gastric and Small Bowel High-Resolution Manometry	p. 59
Fasting State	p. 60
Fed State	p. 62
Anorectal Manometry	p. 71
Normal High-Resolution Anorectal Manometry	p. 71
Normal Anal Sphincter	p. 71
Cough Reflex	p. 80
Oscillating Pressure Waves	p. 80
Anoanal Reflex	p. 80
Rectal Response to Balloon Distention	p. 80
Abnormal High-Resolution Anorectal Manometry	p. 80
Dyssynergic Defecation	p. 80
Hirschsprung's Disease	p. 80
Troubleshooting	p. 88
Index	p. 89
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