Assessment of oesophageal emptying in achalasia patients by intraluminal impedance monitoring

Oesophageal emptying can be assessed by radiographic and scintigraphic tests with radiation exposure or by multichannel intraluminal impedance monitoring (MII). The aim of this study was to evaluate the applicability of MII for the assessment of oesophageal emptying in achalasia patients. In 10 achalasia patients, impedance tracings were scored independently by three observers after ingestion of a 100-mL barium bolus. Bolus clearance time (BCT) and height of barium column were scored using fluoroscopic images acquired at 20-s intervals. All patients showed a low baseline impedance level in the distal oesophagus. Air trapping in the proximal oesophagus was detected in nine patients. BCT on MII was similar to that on fluoroscopy in 40-70% of the patients. Correlations between height of barium on fluoroscopy and fluid level on MII were poor to moderate at different time intervals. Concordance (Kendall's coefficient) between the three observers for assessment of fluid level on MII was 0.31 (P = 0.04) at 1 and 5 min, 0.26 (P = 0.08) at 10 and 0.44 (P = 0.01) at 15 min. We conclude that in achalasia patients, low baseline impedance levels and air entrapment in the proximal oesophagus limit the value of intraluminal impedance monitoring as a test of oesophageal emptying

Colitis colágena: estudio clinicopatológico de seis nuevos casos

Collagenous colitis (CC) is a newly recognized entity characterized clinically by chronic watery diarrhoea and pathologically by epithelial inflammatory injury and the presence of a thickened collagen band beneath the surface epithelium of the colon. Clinical and pathological data of six patients (5 women and 1 man, mean age 54 years) with this diagnosis have been reviewed. Chronic watery diarrhoea was the main sympton in all cases, ranging from 2 to 12 bowel movements a day (mean ± SD, 5,5 ± 2,3) lasting from 8 months to 19 years (mean ± SD, 6,6 ± 5,9 years). Laboratory, barium and endoscopic studies showed unspecific findings. Rheumatic and thyroid diseases as well as drug allergies were found in five cases. The cause of collagenous colitis and the mechanism of diarrhoea remains undefined, being the inflammatory and autoinmune hypothesis the most likely. Diagnosis was made by multiple rectal and colonic biopsies. Pathologic findings characteristic of CC were more prominent in proximal than in distal colonic specimens. Different treatments were applied and diverse clinic responses were obtained. A review of the literature is made

Esophageal mucosal integrity improves after laparoscopic antireflux surgery in children with gastroesophageal reflux disease

Background: Esophageal intraluminal baseline impedance reflects the conductivity of the esophageal mucosa and may be an instrument for in vivo evaluation of mucosal integrity in children with gastroesophageal reflux disease (GERD). Laparoscopic antireflux surgery (LARS) is a well-established treatment option for children with proton pump inhibitory (PPI) therapy resistant GERD. The effect of LARS in children on baseline impedance has not been studied in detail. The aim of this study was to evaluate the effect of LARS on baseline impedance in children with GERD. Methods: This is a prospective, multicenter, nationwide cohort study (Dutch national trial registry: NTR2934) including 25 patients [12 males, median age 6 (range 2–18) years] with PPI-resistant GERD scheduled to undergo LARS. Twenty-four hour multichannel intraluminal impedance pH monitoring (MII-pH monitoring) was performed before and 3 months after LARS. Baseline impedance was evaluated during consecutive 2-h intervals in the 24-h tracings. Results: LARS reduced acid exposure time from 8.5 % (6.0–16.2 %) to 0.8 % (0.2–2.8 %), p < 0.001. Distal baseline impedance increased after LARS from 2445 Ω (1147–3277 Ω) to 3792 Ω (3087–4700 Ω), p < 0.001. Preoperative baseline impedance strongly correlated with acid exposure time (r −0.76, p < 0.001); however, no association between symptomatic outcome and baseline impedance was identified. Conclusions: LARS significantly increased baseline impedance likely reflecting recovery of mucosal integrity. As the change in baseline impedance was not associated with the clinical outcome of LARS, other factors besides mucosal integrity may contribute to symptom perception in children with GERD

La macrobiopsia endoscópica en el diagnóstico de la enfermedad de Menetrier

For the anatompathological diagnosis of Menetrier's disease to be made, it is necessary to have a biopsy covering the entire thickness of the mucosa. Until a few years ago, to obtain this it was necessary to resort to a surgical biopsy performed during the course of a laparotomy. We present our experience in 6 patients suffering from this disease, in whom the conventional biopsies taken during the course of a gastroscopy, did not enable us to make the anatomopathological diagnosis of the said entity. The performing during the same exploration of an endoscopic macrobiopsy taken with a polypectomy loop provided us with the diagnosis. The simplicity, harmlessness and abscence of complications as well as its diagnostic efficiency, along with the fact that a laparotomy is avoided, mean that this technique is vitally important in the diagnosis of Menetrier's disease

Tratamiento de la cirrosis biliar primaria con ácido ursodesoxicólico. Resultados a corto y medio plazo y relación con el estudio de la enfermedad

We present the results of the treatment with ursodeoxycholic acid (UDCA, 7-9 mg/kg body weight daily) of 17 patients with primary biliary cirrhosis (8 in stages I-II; 9 in stages III-IV). At two months the mean values of alkaline phosphatase, gammaglutamiltranspeptidase, alanine and aspartate aminotransferase were reduced (p less than 0.001, p less than 0.001, p less than 0.01 and p less than 0.01 respectively). This improvement persisted without increase during the first year. At two months the total bilirubin value was reduced (p less than 0.01) associated with a reduction in the conjugated fraction (p less than 0.05). Cholesterol and gammaglobulin mean values also decreased at two months (p less than 0.05). We found no changes in IgM levels and antimitochondrial antibody titers. The improvement was similar in both groups (early I-II and advanced III-IV stages) and the treatment showed no undesirable effects either in early or advanced stages. Almost all the patients with pruritus (6 out of 7) improved with the treatment and the use of cholestyramine was reduced in al

Intraesophageal impedance monitoring: clinical studies

Electrical impedance (Z) between two electrodes is the ratio between applied voltage (U) and resulting current (I). In electrical impedance monitoring the resistance to electrical flow in an alternating current circuit is measured. Multichannel esophageal monitoring can be measured by using an intraluminal catheter with multiple, closely spaced pairs of metal rings. Changes in temporal-spatial patterns in impedance are identified at various levels within the esophagus, allowing differentiation between antegrade (swallow) and retrograde (reflux) bolus movement. Esophageal impedance monitoring can be used to assess the clearance of a swallowed bolus (esophageal transit) and to detect gastro-esophageal reflux independent of its acidity. In the first part of the thesis, the value of intraesophageal impedance monitoring as a tool to assess esophageal transit was studied in normal subjects, patients with non-obstructive dysphagia and achalasia patients. In the second part, gastro-esophageal reflux patterns was studied using impedance monitoring in patients with functional dyspepsia, patients with gastro-esophageal reflux disease treated with endoscopic gastroplication as well as in patients with erosive esophagitis and non-erosive reflux disease. Using combined impedance and perfusion manometry, normal esophageal bolus clearance was defined as complete clearance of at least 70% of liquid boluses and at least 60% of viscous boluses. Impedance recording identifies esophageal function abnormalities in non-obstructive dysphagia patients with normal manometry, ineffective esophageal motility and diffuse esophageal spasm. The impedance technique seems to be less suitable for the most severe end of the dysphagia spectrum like achalasia. In achalasia patients, low-baseline impedance levels and air entrapment in the proximal esophagus limit the value of intraluminal impedance monitoring as a test of esophageal emptying. Patients with functional dyspepsia swallow air more frequently than controls and this abnormality is associated with an increased incidence of non-acid gaseous gastro-esophageal reflux. Impedance monitoring can identify the specific effect of endoscopic gastroplication on the different types of reflux episodes with regard to gas-liquid composition and pH, as well as on volume clearance and the proximal extent of the refluxate. Whereas patients with erosive esophagitis have more acid reflux episodes in the supine position than patients with non-erosive reflux disease, both groups have similar non-acid reflux patterns