High resolution manometry and new classification of esophageal motility disorders

Purpose of the review. To present application of Chicago classification criteria of esophageal motility disorders defined in high resolution manometry in clinical practice. Basic provisions. High-resolution manometry is the most exact hi-tech diagnostic method for esophageal motor function disorders according to Chicago classification v3.0. Uniqueness of the method consists in capacity to define integrated quantitative and qualitative metrics of esophageal contractile function and to establish their specific disorders e.g.: change of intrabolus pressure at disorders of esophagogastric junction (EGj) outflow, hypercontractile esophagus, fragmented contractions and weak or failed peristalsis, distal esophageal spasm. Assessment of the type of achalasia subtypes has significant impact on the patients’ treatment choice. According to anatomical location of the lower esophageal sphincter and crural diaphragm several morphological types of gastro-esophageal junction are defined that determine severity of gastroesophageal reflux disease. Multiple rapid swallow responses during esophageal high-resolution manometry reflect esophageal body peristaltic reserve and is a predictor of postoperative complications. Differential diagnosis of belching type became possible at combined application of high-resolution manometry and impedance measurement. Conclusion. High-resolution manometry is a fundamental diagnostic test of esophageal motor function disorders. Clinical application of this method significantly expands diagnostic potential and allows to carry out personalized treatment that increases treatment quality

Macrophage phenotype after human refluxate exposure, esophageal dysmotility and their correlation with gastroesophageal reflux disease

Aim of the study. To investigate the esophageal dysmotility, changes in the esophageal mucosa and the immune response depending on the type of refluxate in gastroesophageal reflux disease (GERD) patients.Material and methods. 68 patients with GERD were recruited: 28 (14 men; mean age, 45.74 ± 2.23 years) nonerosive reflux disease (NERD), 22 (15 men; mean age, 45.0 ± 3.24 years) erosive reflux disease (EE), 18 (13 men; mean age, 47.22 ± 2.95) Barrett’s Esophagus (BE). GERD patients underwent esophageal high-resolution manometry (HRM) with a 22-channel water-perfused catheter and Solar GI system (Medical Measurements Systems, Enschede, the Netherlands), 24-hour impedance and pH monitoring using the Ohmega Ambulatory Impedance pH Recorder (Medical Measurements Systems). We analyzed receptor characteristics of monocyte-derived macrophages in all groups of patients.Results. On HRM examination, we showed that DCI (distal contractile integral) in NERD patients was higher than in EE (p = 0.088) and BE (p = 0.076), also LES RP (lower esophageal sphincter resting pressure) in NERD patients was higher than in EE (p = 0.039) and BE (p = 0.012). The analysis of reflux characteristics showed that the total reflux time with pH < 4 for BE patients was longer than that for NERD and EE patients. An analysis of receptor characteristics of monocyte-derived macrophages showed the prevalence of CD25 and CD80 expression in all groups of patients.Conclusion. An analysis of the phenotype of macrophages derived from blood monocytes of GERD patients revealed a prevalence of М1 macrophages that was typical for the Th1 type of immune response. The degree of esophageal dysmotility was correlated with GERD severity and type

Microbiota of the Esophagus and Stomach in Patients with Gastroesophageal Reflux Disease and Healthy Volunteers

This paper is aimed at investigating the microbiota of the esophagus and stomach in patients with gastroesophageal reflux disease (GERD) and healthy volunteers.Materials and methods.  The study included 15 patients suffering from GERD and 6 healthy volunteers. All subjects underwent sampling of esophageal and gastric contents. The study of the microbiota in the obtained samples was performed by sequencing the 16S gene of ribosomal RNA (rRNA).Results.  The most common types of bacteria in the esophagus and stomach in patients with GERD and healthy volunteers are found to be Bacteroidetes, Firmicutes, Actinobacteria, Proteobacteria, Fusobacterium. By comparing the relative contents of the main types of bacteria in the esophageal mucus and gastric contents, a significant decrease in the proportion of Proteobacteria was observed in patients with GERD as compared to healthy volunteers. The decrease in the relative number of bacteria belonging to the Acetobacteraceae, Bacillaceae, Bdellovibrionaceae, Clostridiales Insertae Sedis XI, Fusobacteriaceae, Moraxellaceae, Pasteurellaceae and Rhodocyclaceae families was observed in the esophagus in patients with GERD as compared to healthy volunteers. A higher bacterial content of the Leptotrichiaceae and Veillonellaceae families was detected in the stomach of patients with GERD.Conclusions.  The obtained results indicate differences in the intraluminal microbiota of the esophagus and stomach in patients with GERD and healthy volunteers. Further study should be carried out to study the effect of changes in bacterial composition on those in the esophagus and stomach

Microbiota of the Esophagus and Stomach in Patients with Gastroesophageal Reflux Disease and Healthy Volunteers

This paper is aimed at investigating the microbiota of the esophagus and stomach in patients with gastroesophageal reflux disease (GERD) and healthy volunteers.Materials and methods.  The study included 15 patients suffering from GERD and 6 healthy volunteers. All subjects underwent sampling of esophageal and gastric contents. The study of the microbiota in the obtained samples was performed by sequencing the 16S gene of ribosomal RNA (rRNA).Results.  The most common types of bacteria in the esophagus and stomach in patients with GERD and healthy volunteers are found to be Bacteroidetes, Firmicutes, Actinobacteria, Proteobacteria, Fusobacterium. By comparing the relative contents of the main types of bacteria in the esophageal mucus and gastric contents, a significant decrease in the proportion of Proteobacteria was observed in patients with GERD as compared to healthy volunteers. The decrease in the relative number of bacteria belonging to the Acetobacteraceae, Bacillaceae, Bdellovibrionaceae, Clostridiales Insertae Sedis XI, Fusobacteriaceae, Moraxellaceae, Pasteurellaceae and Rhodocyclaceae families was observed in the esophagus in patients with GERD as compared to healthy volunteers. A higher bacterial content of the Leptotrichiaceae and Veillonellaceae families was detected in the stomach of patients with GERD.Conclusions.  The obtained results indicate differences in the intraluminal microbiota of the esophagus and stomach in patients with GERD and healthy volunteers. Further study should be carried out to study the effect of changes in bacterial composition on those in the esophagus and stomach