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Background: The confirmatory test for sphincter of Oddi dysfunction (SOD) is manometry (SOM) which may be hazardous. When SOM is equivocal, the decision to treat by sphincterotomy, entailing further risk, [...]

Background: Children with abdominal pain, vomiting, and/or bloating often have gastric dysfunction such as delayed gastric emptying (GE). GE studies on children are difficult to perform due to the necessity [...]

Background and Aims: Enteral feed given as a bolus has a half emptying time (t 1/2) of 90 min. No data are available on gastric emptying patterns during continuous nasogastric [...]

Introduction: Identification of LOS by visual inspection at endoscopy is unreliable and often impossible. Knowledge of the sphincter position detected by station pull through manometry (SPM) can not be effectively [...]

Introduction: Sphincter of Oddi dysfunction (SOD) represents a difficult diagnostic challenge. Sphincter of Oddi manometry is the gold standard diagnostic method, but this is technically difficult, carries significant risk, and [...]

Introduction: Patients with globus sensation are usually referred to an ENT specialist for possible malignancy. However, in most patients, flexible laryngoscopy shows no abnormalities, and further management is often unclear. [...]

Background: Small bowel manometry (SBM) has widely been used to investigate adult patients with gastrointestinal motility disorder. However, the use of this technique to paediatrics is uncommon. The aim of this study was to evaluate feasibility of SBM on paediatric patients with suspected small intestinal motility disorder. Methods: We have performed SBM on 14 paediatric patients (age range 2-10 years) who had symptom(s) including recurrent abdominal pain (n = 10), nausea (n = 5), vomiting (n = 7), abdominal distension (n = 2) and constipation (n = 2). A 3-channel manometry catheter was introduced nasally and placed in the proximal small bowel under fluoroscopic control. Ambulatory recordings were made for 24 hours using a portable recorder. Recorded data were analysed using dedicated software. Results: Four had normal motility when applied to the normal ranges in adults. At least one of the following abnormalities was found in eight patients; possible neuropathy findings including excess of motor activity (n = 3), prolonged Phase III (n = 2), Phase III-like prolonged bursts (n = 3), non-propagated Phase III (n = 2), retrograde propagation of Phase III (n = 2), and Iow-amplitude Phase III (n = 1) suggesting possible myopathy. Intubation failed in two patients due to no migrations of the catheter into the small intestine. Summary: In this study a high proportion of the patients had abnormal small intestinal motility and this suggests that SBM can be used to evaluate those conditions. Normal values during infant and childhood development need establishing before adopting the technique for clinical diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Circadian rhythms for protein transcription have recently been identified in the gut? Environmental synchronizers may reset biological clocks, leading to alteration in gut functions, but alteration in bowel transit due to time zone shifts experienced in long haul flight is yet to be reported. Methods: Six men (Age 33.2 +/- 10.6 years) and 3 women (36.7 +/- 7.2) (mean +/- 1 SD) flew from London to California, USA, and back. As a pre-condition to joining the study, they were on no drugs for digestive diseases. We elicited responses pre-, in-, and post-flight and during foreign stay about their bowel habit, stool form scale and abdominal symptoms using validated questionnaires. Paired t-tests were used to examine significant changes in sleep and stool form scale from the pre-flight level. Stool form scale may be used as o guide to intestinal transit time. Results: Sleep duration and times pre-flight, during foreign stay and post flight were not significantly different (p > 0.05). Additionally, there was no reason to believe that the stool changes were attributable to a drastic change in diet. Abdominal symptoms were unremarkable and did not change during foreign stay or on return home from abroad. All our subjects were normal and had an uneventful stay abroad. Average stool consistency changed significantly (p < 0.01) from a lumpy to smooth consistency to a smooth to soft consistency during foreign stay and persisted 4-5 days into post-flight. The respective stool form sca[es were pre-flight 2.8 +/- 1.0, foreign stay 3.5 +/-1.1, post-flight 3.7 +/-1.2. Summary and Conclusion: During a time zone shift of +/- 8h, while the sleep clock was synchronized with the external chock, gut transit, as measured by the stool form scale, failed to synchronize with the external clock, leading to altered bowel habit. Biologic clocks that regulate gut functions may not adapt as readily to time shifts, as does the sleep clock. [ABSTRACT FROM AUTHOR]

Sphincter of Oddi dysfunction (SOD) is a cause of postcholecystectomy pain. Current gold-standard diagnosis is by measurement of basal pressure by sphincter of Oddi manometry (SOM), and if elevated an endoscopic sphincterotomy (ES) is performed. Both these procedures carry significant complication rates. Hepatobiliary scintigraphy has been promoted as a means of assisting management. Aim: to evaluate hepatobiliary scintigraphy (HBS) as a means of screening for SOD and predicting treatment response. Methods: 21 post-cholecystectomy patients were screened by HBS prior to standard evaluation with SOM during ERCP. HBS was performed using a standard protocol. A semi-quantitative scoring system classified scans as positive (SOD) or negative (no SOD). Two observers reviewed all 21 scintigrams. SOM was regarded as diagnostic of SOD if sphincter base pressure was > 40 mm Hg. If elevated, an ES was performed and a successful result was defined as an improvement in symptoms. Results: 17 of our patients were female, average age 42.4 + 4.0 years. Agreement was 100% between observers. Conclusions: HBS can be interpreted reliably between observers. HBS is a poor screening tool in isolation, but may prove a useful adjunct to manometry in predicting ES outcome. [ABSTRACT FROM AUTHOR]

23 Children aged between 11 months and 15.5 years were seen in our clinic within the period October 01 2001-2002. They presented with feeding difficulties that required oesophageal manometry, among other diagnostic investigations. The commonest symptoms were dysphagia for solids, regurgitation, and vomiting, in order of frequency. Lower Oesophageal Sphincter (LOS) pressure and body motility were measured using a standard eight channel, water perfused adult catheter (3.9 mm diameter) or a 2.3 mm catheter purpose designed for paediatric use (Mediplast). LOS pressure and oesophageal body motility were measured using a Flexilog 4000 recording system. Nine out of 23 patients had a hypertensive LOS (pressure > 26 mm Hg). These patients with hypertensive LOS but without achalasia often had regurgitation and vomiting as major presenting symptoms. Only 2 out of 23 patients had achalasia and only one of the two had a hypertensive LOS. Non-specific motility disorder (7/23), in which there were few peristaltic waves with a majority of simultaneous contractions, was the commonest cause of dysphagia. Of significance was a subgroup (4/23) with a partially relaxing LOS (residual pressure 6-11 mm Hg) but who did not have achalasia. This group had varied symptoms such as vomiting, regurgitation, and dysphagia for solids. A large hiatus hernia (7 cm) was the only finding in an adolescent girl with unexplained vomiting, normal oesophageal body motility, and "normal" OGD. in summary, children with feeding problems who present with regurgitation, vomiting, and dysphagia for solids are most likely to have a hypertensive LOS or non-specific oesophageal dysmotility rather than achalasia. Unexplained vomiting with normal LOS function and body motility may be due to hiatus hernia, which could be missed during OGD. In conclusion, oesophageal manometry is an essential diagnostic tool in the investigation of upper gastrointestinal manifestations. From our experience, it is best suited to... [ABSTRACT FROM AUTHOR]

Objective: Current diagnostic methods for gastro-oesophageal reflux disease (GORD) have moderate sensitivity/specificity and can be invasive and expensive. Pepsin detection in saliva has been proposed as an 'office-based' method for GORD diagnosis. The aims of this study were to establish normal values of salivary pepsin in healthy asymptomatic subjects and to determine its value to discriminate patients with reflux-related symptoms (GORD, hypersensitive oesophagus (HO)) from functional heartburn (FH)., Design: 100 asymptomatic controls and 111 patients with heartburn underwent MII-pH monitoring and simultaneous salivary pepsin determination on waking, after lunch and dinner. Cut-off value for pepsin positivity was 16 ng/mL. Patients were divided into GORD (increased acid exposure time (AET), n=58); HO (normal AET and + Symptom Association Probability (SAP), n=26) and FH (normal AET and-SAP, n=27)., Results: 1/3 of asymptomatic subjects had pepsin in saliva at low concentration (0(0-59)ng/mL). Patients with GORD and HO had higher prevalence and pepsin concentration than controls (HO, 237(52-311)ng/mL and GORD, 121(29-252)ng/mL)(p<0.05). Patients with FH had low prevalence and concentration of pepsin in saliva (0(0-40) ng/mL). A positive test had 78.6% sensitivity and 64.9% specificity for diagnosis of GORD+HO (likelihood ratio: 2.23). However, one positive sample with >210 ng/mL pepsin suggested presence of GORD+HO with 98.2% specificity (likelihood ratio: 25.1). Only 18/84 (21.4%) of GORD+HO patients had 3 negative samples., Conclusion: In patients with symptoms suggestive of GORD, salivary pepsin testing may complement questionnaires to assist office-based diagnosis. This may lessen the use of unnecessary antireflux therapy and the need for further invasive and expensive diagnostic methods., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objective: Patients with non-erosive reflux disease (NERD) have impaired oesophageal mucosal integrity (dilated intercellular spaces). Oesophageal mucosal integrity reflects the balance between repeated reflux damage and mucosal recovery. The relationship between mucosal integrity and acid sensitivity is unclear. Oesophageal impedance may be used for in vivo mucosal integrity measurement. We studied acid-induced changes in oesophageal mucosal integrity and acid perception in patients with heartburn., Design: 50 patients with heartburn whithout oesophagitis underwent impedance monitoring before, during and after 10 min oesophageal perfusion with neutral (pH 6.5) and acid solutions (pH 1). Symptoms and impedance were recorded during perfusion. Impedance recovery was assessed for 2 h post-perfusion in ambulatory conditions followed by 24-h impedance-pH study., Results: Reflux monitoring discriminated 20 NERD and 30 functional heartburn (FH) patients. Neutral perfusion caused impedance fall that recovered within 10 min. Acid perfusion caused impedance fall with slow recovery: 6.5 Ω/min (IQR 3.3-12.0 Ω/min). Patients with slow recovery (< 25th percentile) had lower baseline impedance (1273 Ω ± 208 Ω vs. 3220 Ω ± 275 Ω ±, p < 0.01) and more frequent acid sensitivity (10/12 vs. 4/12, p = 0.04) than those with fast (> 75th percentile) recovery. Patients with NERD had lower baseline impedance (1669 ± 182 Ω vs. 2384 ± 211 Ω, p = 0.02) and slower impedance recovery (6.0 ± 0.9 Ω/min vs. 10.7 ± 1.6 Ω/min, p = 0.03) than patients with FH., Conclusion: Impaired mucosal integrity might be the consequence of repeated reflux episodes with slow recovery. Mucosal integrity, recovery capacity and symptom perception are linked. Low basal impedance and slow recovery after acid challenge are associated with increased acid sensitivity.