Gerson Ricardo Domingues1, Nelson Henrique Michelsohn2,3, Ricardo Guilherme Viebig4, Décio Chinzon5, Ary Nasi3,6, Carla Granja Andrade7, Eponina Maria Lemme8, Luiz João AbrahÃo Junior8, Mauricio Gustavo Bravim9, Miguel Ângelo Nobre-E-Souza10, Nayara Salgado Carvalho11, Paulo J P C Carvalho11, Tomás Navarro Rodrigues12, Joaquim Prado P Moraes Filho13. 1. Universidade do Estado do Rio de Janeiro, Departamento de Medicina Interna, Disciplina de Gastroenterologia, Rio de Janeiro, RJ, Brasil. 2. Centro de Motilidade Digestiva (CDM), São Paulo, SP, Brasil. 3. Fleury Medicina e Saúde, Departamento de Motilidade, São Paulo, SP, Brasil. 4. Instituto Brasileiro de Estudos e Pesquisas de Gastroenterologia e Especialidades (IBEPEGE), Motilidade Digestiva e Neurogastroenterologia (MoDiNe), São Paulo, SP, Brasil. 5. Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brasil. 6. Universidade de São Paulo, Departamento de Motilidade, São Paulo, SP, Brasil. 7. CGA Centro Especializado em Neurogastroenterologia e Motilidade Digestiva, São Paulo, SP, Brasil. 8. Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Clínica Médica, Rio de Janeiro, RJ, Brasil. 9. Centro de Motilidade do Aparelho Digestivo (CEMAD), Belo Horizonte, MG, Brasil. 10. Universidade Federal do Ceará, Faculdade de Medicina, Fortaleza, CE, Brasil. 11. Hospital Israelita Albert Eisntein, Núcleo de Fisiologia Gastrointestinal (NUFIG), São Paulo SP, Brasil. 12. Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Serviço de Gastroenterologia e Hepatologia Clínica, São Paulo, SP, Brasil. 13. Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia São Paulo, SP, Brasil.
Abstract
BACKGROUND: The high-resolution manometry has been a significant advance in esophageal diagnostics. There are different types of catheter and systems devices to capture esophageal pressures that generate variable data related to Chicago Classification (CC) and consequently influence normal values results. There are not normative data for the 24-channel water-perfused high-resolution manometry system most used in Brazil with healthy volunteers in supine posture. OBJECTIVE: To determine manometric esophageal normative values for a 24-channel water-perfused high-resolution manometry catheter in supine posture using healthy volunteers according to CC 3.0 parameters. METHODS: A total of 92 volunteers with no gastrointestinal symptoms or medications affecting GI motility underwent esophageal high-resolution manometry by standard protocol. Age, gender and manometry parameters analyzed using Alacer software were collected. The median, range, and 5th and 95th percentiles (where applicable) were obtained for all high-resolution manometry metrics. Normal value percentiles were defined as 95th integrated relaxation pressure, 5th-100th distal contractile integral, and 5th distal latency. RESULTS: The mean age was 40.5±13.2 years. Our normative metrics were integrated relaxation pressure <16 mmHg and distal contractile integral (708-4111 mmHg.cm.s) distal latency was <6 s and peristaltic break size (>4 cm). For EGJ-CI the range 5th-95th was 21.7-86.9 mmHg.cm.s. CONCLUSION: This is the first report of normative data for the 24-channel water-perfused system in supine posture. It revealed higher integrated relaxation pressure and distal latency duration which suggest the need to change CC 3.0 cutoffs for this system. It is observed that there is a tendency that DCI >7000 mmHg.cm.s may represent the lower limit of hypercontractility, and when <700 mmHg.cm.s (<5% percentile) interpreted as ineffective esophageal motility or failcontraction. Also compared to Chicago 3.0, higher integrated relaxation pressure and duration of distal latency were found. We emphasize that these data must be confirmed by future studies.
BACKGROUND: The high-resolution manometry has been a significant advance in esophageal diagnostics. There are different types of catheter and systems devices to capture esophageal pressures that generate variable data related to Chicago Classification (CC) and consequently influence normal values results. There are not normative data for the 24-channel water-perfused high-resolution manometry system most used in Brazil with healthy volunteers in supine posture. OBJECTIVE: To determine manometric esophageal normative values for a 24-channel water-perfused high-resolution manometry catheter in supine posture using healthy volunteers according to CC 3.0 parameters. METHODS: A total of 92 volunteers with no gastrointestinal symptoms or medications affecting GI motility underwent esophageal high-resolution manometry by standard protocol. Age, gender and manometry parameters analyzed using Alacer software were collected. The median, range, and 5th and 95th percentiles (where applicable) were obtained for all high-resolution manometry metrics. Normal value percentiles were defined as 95th integrated relaxation pressure, 5th-100th distal contractile integral, and 5th distal latency. RESULTS: The mean age was 40.5±13.2 years. Our normative metrics were integrated relaxation pressure <16 mmHg and distal contractile integral (708-4111 mmHg.cm.s) distal latency was <6 s and peristaltic break size (>4 cm). For EGJ-CI the range 5th-95th was 21.7-86.9 mmHg.cm.s. CONCLUSION: This is the first report of normative data for the 24-channel water-perfused system in supine posture. It revealed higher integrated relaxation pressure and distal latency duration which suggest the need to change CC 3.0 cutoffs for this system. It is observed that there is a tendency that DCI >7000 mmHg.cm.s may represent the lower limit of hypercontractility, and when <700 mmHg.cm.s (<5% percentile) interpreted as ineffective esophageal motility or failcontraction. Also compared to Chicago 3.0, higher integrated relaxation pressure and duration of distal latency were found. We emphasize that these data must be confirmed by future studies.
Authors: Pedro Norton; Fernando A M Herbella; Francisco Schlottmann; Marco G Patti Journal: Langenbecks Arch Surg Date: 2021-08-31 Impact factor: 3.445
Authors: Benjamin D Rogers; Arvind Rengarajan; Luiz Abrahao; Shobna Bhatia; Serhat Bor; Dustin A Carlson; Daniel Cisternas; Sutep Gonlachanvit; Albis Hani; Jamal Hayat; Osamu Kawamura; Yeung Yeh Lee; Ana Maria Leguizamo; Ans Pauwels; Julio Perez de la Serna; Rosa I Ramos; Jose Maria Remes-Troche; Sabine Roman; Edoardo Savarino; Jordi Serra; Daniel Sifrim; Salvatore Tolone; Zhiqin Wong; Frank Zerbib; John Pandolfino; C Prakash Gyawali Journal: Neurogastroenterol Motil Date: 2020-10-23 Impact factor: 3.960