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Objective: To define the prevalence and severity of esophageal involvement in systemic sclerosis (SSc) and its relationship with the different clinical forms and ANA specificities of the disease., Methods: A hundred consecutive patients with SSc, 48 with cutaneous limited, 26 with intermediate and 26 with diffuse form of disease, 49 with anti-centromere and 37 with anti-Scl70 ANA pattern, were submitted to scintigraphy using a semisolid orally ingested bolus to detect esophageal hypomotility., Results: An impairment of esophageal function has been observed in 68% of SSc patients. Esophageal dysmotility was significantly more frequent and severe in patients with cutaneous diffuse and intermediate forms of SSc and with anti-Scl70 ANA pattern., Conclusions: Esophageal involvement is very common in SSc. The scintigraphy confirms to be a useful and non invasive diagnostic method; moreover it permits to quantify the severity of the esophageal dysmotility by analyzing both global and segmental function.

Esophageal motor function was studied in 14 patients affected with diffuse and (multi)nodular nontoxic goiter, with dysphagia and neck discomfort, and in 10 age-matched controls without thyroid and/or gastroesophageal diseases. Esophageal manometry was employed to evaluate upper esophageal sphincter pressure (UESP) and lower esophageal sphincter pressure (LESP), amplitude, duration and propagation velocity of peristaltic contractions and the presence of simultaneous deglutitive pressure waves. Esophageal transit was evaluated by radioisotopical method, at different times, in proximal, middle and distal esophagus. LESP was significantly lower (p < 0.001) in goitrous patients compared with controls. No difference was, on the contrary, found in the UESP, esophageal peristaltic wave amplitude and duration. Significantly (p < 0.05) increased propagation velocity of the peristaltic contractions and the presence of simultaneous deglutitive pressure waves in distal esophagus were observed in goitrous patients. Esophageal transit delay was found early in proximal and middle, and, at all times, in distal part of the esophagus of nontoxic goitrous patients. It is concluded that esophageal transit delay, early in the upper and prolonged in the lower part of the esophagus, represents the main findings of the esophageal dysfunction in the patients with nontoxic goiter and dysphagia.

Background: Recent studies suggest that esophageal dysmotility occurring in systemic sclerosis might be caused by neurotransmitter levels decrease. The aim of the present study is to value VIP plasma levels, and to relate them with the pressure of the inferior esophageal sphincter (IES) and the capillaroscopy score in a group of patients affected by Systemic Sclerosis (SSc)., Methods: Eleven subjects affected by SSc (eight male and three female, age from 30 to 72 years old) have been studied through esophageal manometry, capillaroscopy and VIP plasma levels evaluation. Fifteen healthy volunteers, as control group, have been enlisted., Results: Our results show a decrease of VIP plasma levels in patients with SSc compared with control group. The difference between two groups has statistical significance (p < 0.01). Capillaroscopy has shown remarkable microcirculatory impairment and the esophageal manometry proved a decreased IES pressure. The scores of capillaroscopy, VIP plasma levels and pressures of IES have been compared and it has been observed that there is a relationship between VIP plasma level and pressure of IES., Conclusions: VIP plasma levels decrease enhances the role of the autonomic disorder in SSc and may contribute to produce the alteration of vascular tone as well as the gastroenteric musculature dysfunction.

The above study is an analysis of different dyspeptic syndromes outlining their pathophysiology and clinical features. On this basis, the authors suggest a diagnostic strategy, stressing the importance of certain elements such as age at onset, duration and variability of symptoms. This allows to evaluate the indications for endoscopy or biopsy, or to decide that it is sufficient to continue observation while reassuring the patient that the dyspeptic condition is benign.

The intraoperative esophageal manometry (IEM) has been used to improve results in operative management of gastroesophageal reflux and achalasia. The IEM pointed out the necessity to perform an antireflux procedure with an intraoperative sphincter pressure higher than normal, because the measured postoperative sphincter pressures were one-half the intraoperative values measured after repair. Nevertheless some authors failed to find any correlation between intraoperative and subsequent postoperative sphincter pressure measurements. The Authors, in their experience, achieved the same results with and without IEM in the surgical management of gastroesophageal reflux and achalasia. For this reason The IEM does not seem to be necessary when performing the standard Nissen or Heller procedure. It is probably useful in the surgical treatment of patients with motor disorders or sclerodermia associated with reflux and in patients who have had multiple prior operations for reflux or achalasia.

Intra-operative esophageal electromanometry (IEM), a method foretold by the authors since 1972, is indicated in the course interventions for functional esophageal disease. The main application of IEM occurs in the presence of myotomy and in the preparation of anti-reflux plasty. As far as myotomy is concerned, IEM can provide guidance in identifying a site for future intervention and, once accomplished, for documenting the completeness thereof. As far as anti-reflux plasty is concerned, it provides an opportunity to verify the onset of an anti-reflux high-pressure zone (nHPZ) that can be calibrated fittingly until the required values are achieved. IEM appears especially useful in effecting a Nissen fundoplication, the frightful complications of which compel many a surgeon to use other types of plasty, despite the lower rate of effectiveness. The perfect identity between the degree of loop closing and the manometric values obtained, and between the loop width and the length of the nHPZ, obtainable through Nissen's fundoplication only, testifies in favor of the use of IEM in preparation of this type of fundoplication only. The Authors present their case studies from 1985 to date, collected at the Service of Surgical Esophagology of the Faculty of Naples, covering 145 cases of Nissen's fundoplication, 70 of which after extramucosal cardias myotomy according to Heller, 54 cases of GER, including 2 cases of scleroderma, epiphrenic diverticula, DES and repeated surgery.

The authors report on their experience acquired in the surgical treatment of functional esophageal disease (achalasia, diffuse esophageal spasm, diverticula and gastroesophageal reflux). The authors affirm that a correct and meticulous functional study of the esophagus is fundamental for the adoption of precise surgical plotting, in order to circumvent all of the complications and failures described in Literature. Such an objective can be achieved intraoperatively thanks to myotomy and fundoplication with the aid of intraoperative manometry (IEM) that, when performed in the course of myotomy, circumvents the execution of incomplete procedures (incomplete myotomies). The same holds true in the case of anti-reflux plasty (Nissen's in particular) where IEM enables a plication that is neither too wide nor too narrow, too long, too short, but "calibrated". Then, instrumental probes are even more capable of assessing the effects of functional surgery, by enabling the documentation of perfect postoperative results. More precisely they make it possible to study patients presenting with motor disorders pre-operatively, as in the case of achalasia or diverticula, and to sanction their resolution postoperatively. In addition they enable documentation of the effectiveness of Nissen's fundoplication, performed either to prevent gastroesophageal reflux after myectomy or to treat primary reflux. This is made possible by studying not only the tone at a distance, but especially relaxation in the course of deglutition. Finally, pH-metry permits the documentation of the complete clearing of gastroesophageal reflux, even when physiologic and post-prandial (hypercompetent Nissen).

The authors report their experience about the esophageal manometry in patients with Progressive Systemic Sclerosis (PSS). From January 1987 to December 1991, 32 patients (27 females and 5 males, in the ratio of 5.4 to 1; mean age of 56.6 years, range 18-84) were send to our Department with the diagnosis of PSS. The patients were divided in two group according to the presence or absence of esophageal symptoms. The first group (A) of 12 patients without symptoms, was examined only with manometry, while the second (B) was studied with the 24-hour pH-monitoring and esophagoscopy. In the group A the manometry noticed in 9 cases (75%) various degrees of esophageal motility disorders; in B the 90% of cases had a more or less severe disorder of the peristalsis. Moreover the grade of esophagitis and the importance of the gastroesophageal reflux were proportioned to the motility disorders. The conclusion is that also the subjects with PSS, but without esophageal symptoms, have in a high percentage motility disorders of the viscera. The alterations of the peristalsis increases in the group of symptomatic patients associated with esophagitis and severe reflux. On account of the fact that the esophageal lesions involve not only the LES but also the esophageal body, it is clear that the anti-reflux surgical procedures fail and an early medical therapy is the more adequate treatment.

To study the effect of sclerotherapy of varices on esophageal function, the motility of the tubular esophagus and L5S was recorded in 12 cirrhotic patients. The following results were obtained: abnormal wave patterns in the lower esophagus were frequently present after sclerotherapy; no impact on L5I pressure and function was found; the motility changes induced by the treatment have a tendency to decrease as time goes by except for the amplitude of the wave whose decrease persist long.

Intraluminal manometry was used to assess the motor activity of the oesophagus and upper (UES) and low (LES) oesophageal sphincter in 10 patients, 5 female and 5 male, average age 35.9 range 17-50, suffering from insulin-dependent diabetes mellitus. Non-invasive cardiovascular tests were also performed to evaluate autonomous neuropathy together with control tests of glyco-metabolic compensation (fructosamine and HbA1c). An increase in the basic tone of the UES was observed in 8 patients while in 3 this was associated with its incomplete release. Five patients evidenced aspecific motor disturbance such as spontaneous motor activity characterised by repetitive segmentary waves at times with biphasic appearance. IOS activity was within normal limits. It is considered that these disturbances may be attributable to the autonomous neuropathy that often complicates diabetes mellitus and that oesophageal motor disturbance, albeit aspecific, should be considered an early sign of autonomous neuropathy. It is therefore though that manometric oesophageal study may be considered a useful investigative tool for early evidencing of disturbances linked to autonomous neuropathy.

The aim of the study was to investigate the incidence of the acid reflux and its relationship to the oesophageal motility and to clinic symptoms. Recording of oesophageal manometry under basal and stimulating conditions obtained from 30 patients GERD and 10 healthy controls were assessed. Manometric results were analyzed for the occurrence of failed primary peristalsis, for the occurrence of peristaltic dysfunctions or for hypotensive LES pressure. Motor abnormalities found in the body of the oesophagus during simulated oesophageal reflux were described. The AA. found that there is not a sure correlation between the occurrence of peristaltic dysfunctions and hypotensive LES such as was not possible to find a direct relationship between peristaltic disorders and oesophagitis degree or symptoms.

Twenty-four patients with Raynaud's phenomenon, without ARA criteria for classification, were examined, after clinical history, by means of esophageal manometry, combined gastric and esophageal pH-monitoring, endoscopy. The results showed in these patients a high incidence of esophageal motor abnormalities (66.6%), of gastroesophageal reflux (50%), and of duodenogastric reflux (45.8%).

The aetiology of oesophageal motor disturbances (OMD) including achalasia is unknown. Many causes have been hypothesised including: autoimmune inflammatory lesions, mechanical obstruction, degeneration of the dorsal nucleus of the vagus etc. to explain the anatomopathological lesions of Auerbach's plexus. On the basis of the manometric studies carried out so far on motor disturbances of the oesophagus, it is considered that dyskinesia develop into decompensated achalasia. The disturbance would appear to begin as an oesophageal spasm, turn into vigorous achalasia and finally reach the point of decompensated achalasia characterised by hypotonic, synchronous waves and the absence of relaxation of the lower oesophageal sphincter. A personal series of 76 cases of OMD chosen from among 420 monometries carried out from 1980 to 1987 showed that the duration of the wave, namely the length of time the abnormal pressure is maintained is as important as the pressure of the peristaltic wave and the lower oesophageal sphincter. In fact, wave pressure is generally greater than the systolic pressure of the patient and hence, during contraction, the oesophageal walls are ischaemic and this ischaemia might be the cause of the anatomopathological lesions of Auerbach's plexus observed in decompensated achalasia.