T Omari1,2, F Connor3, L McCall4, L Ferris1,2, S Ellison4, B Hanson5, R Abu-Assi4, S Khurana6, D Moore4. 1. College of Medicine and Public Health, Flinders University, Adelaide, Australia. 2. Centre for Neuroscience, Flinders University, Adelaide, Australia. 3. Department of Gastroenterology, Royal Children's Hospital, Brisbane, Australia. 4. Gastroenterology Unit, Women's & Children's Hospital, Adelaide, Australia. 5. UCL Mechanical Engineering, University College London, London, UK. 6. Paediatric Surgery & Urology, Women's & Children's Hospital, Adelaide, Australia.
Abstract
BACKGROUND: The role of high-resolution esophageal impedance manometry (HRIM) for establishing risk for dysphagia after anti-reflux surgery is unclear. We conducted a prospective study of children with primary gastroesophageal reflux (GER) disease, for whom symptoms of dysphagia were determined pre-operatively and then post-operatively and we examined for features that may predict post-operative dysphagia. METHODS: Thirteen children (aged 6.8-15.5 years) undergoing work-up prior to 360o Nissen fundoplication were included in the study. A dysphagia score assessed symptoms at pre-operative study and post-operatively (mean 1.4 years). A HRIM procedure recorded 5-ml liquid, 5-ml viscous and 2-cm solid boluses. We assessed esophageal motility, esophago-gastric junction (EGJ) morphology, EGJ contractility and pressure-flow variables indicative of bolus distension pressures and bolus clearance pressures. A composite pressure-flow index score was also derived. RESULTS: Pre-operative pressure-flow index was positively correlated with post-operative dysphagia score (viscous bolus r = 0.771, p < 0.005). Of three variables that comprise the pressure-flow index, the ramp pressure measured during bolus clearance was the main driver of the effect seen (viscous bolus r = 0.819, p < 0.005). CONCLUSIONS: In order to mitigate symptoms in relation to anti-reflux surgery, dysphagia symptoms and esophageal function need to be pre-operatively assessed. In patients with normal motility, an elevated pressure-flow index may predict post-operative dysphagia.
BACKGROUND: The role of high-resolution esophageal impedance manometry (HRIM) for establishing risk for dysphagia after anti-reflux surgery is unclear. We conducted a prospective study of children with primary gastroesophageal reflux (GER) disease, for whom symptoms of dysphagia were determined pre-operatively and then post-operatively and we examined for features that may predict post-operative dysphagia. METHODS: Thirteen children (aged 6.8-15.5 years) undergoing work-up prior to 360o Nissen fundoplication were included in the study. A dysphagia score assessed symptoms at pre-operative study and post-operatively (mean 1.4 years). A HRIM procedure recorded 5-ml liquid, 5-ml viscous and 2-cm solid boluses. We assessed esophageal motility, esophago-gastric junction (EGJ) morphology, EGJ contractility and pressure-flow variables indicative of bolus distension pressures and bolus clearance pressures. A composite pressure-flow index score was also derived. RESULTS: Pre-operative pressure-flow index was positively correlated with post-operative dysphagia score (viscous bolus r = 0.771, p < 0.005). Of three variables that comprise the pressure-flow index, the ramp pressure measured during bolus clearance was the main driver of the effect seen (viscous bolus r = 0.819, p < 0.005). CONCLUSIONS: In order to mitigate symptoms in relation to anti-reflux surgery, dysphagia symptoms and esophageal function need to be pre-operatively assessed. In patients with normal motility, an elevated pressure-flow index may predict post-operative dysphagia.
Authors: Taher I Omari; Lucas Wauters; Nathalie Rommel; Stamatiki Kritas; Jenifer C Myers Journal: United European Gastroenterol J Date: 2013-08 Impact factor: 4.623
Authors: J C Myers; N Q Nguyen; G G Jamieson; J E Van't Hek; K Ching; R H Holloway; J Dent; T I Omari Journal: Neurogastroenterol Motil Date: 2012-05-23 Impact factor: 3.598
Authors: Aleksandar P Simić; Ognjan M Skrobić; Richard R Gurski; Vladimir M Šljukić; Nenad R Ivanović; Predrag M Peško Journal: J Gastrointest Surg Date: 2014-08-05 Impact factor: 3.452
Authors: Clara Loots; Maud Y van Herwaarden; Marc A Benninga; David C VanderZee; Michiel P van Wijk; Taher I Omari Journal: J Pediatr Date: 2012-10-25 Impact factor: 4.406
Authors: Richard E Leibbrandt; Phil G Dinning; Marcello Costa; Charles Cock; Lukasz Wiklendt; Guangsong Wang; Jan Tack; Dirk van Beckevoort; Nathalie Rommel; Taher I Omari Journal: Front Syst Neurosci Date: 2016-02-17
Authors: Marinde van Lennep; Eric Chung; Ashish Jiwane; Rajendra Saoji; Ramon R Gorter; Marc A Benninga; Usha Krishnan; Michiel P van Wijk Journal: Dis Esophagus Date: 2022-10-14 Impact factor: 2.822
Authors: Anna Maria Caruso; Mario Milazzo; Vincenzo Tulone; Carlo Acierno; Vincenza Girgenti; Salvatore Amoroso; Denisia Bommarito; Valeria Calcaterra; Gloria Pelizzo Journal: Children (Basel) Date: 2020-11-07