摘要:

Achalasia is an esophageal motility disorder of unknown cause, characterized clinically by dysphagia and regurgitation and diagnosed by manometry and/or barium esophagogram. Good long-term symptomatic relief can be achieved with pneumatic dilatation and myotomy. Botulinum toxin injection and videoendoscopic surgery are being evaluated as less invasive forms of therapy.

ISSN:0257-2753    

DOI:10.1159/000171617

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Coordinated application of videoradiography and solid-state manometry provides insight into the pathophysiology of oropharyngeal dysphagia and helps direct appropriate therapies for a variety of conditions causing this symptom. Controlled evaluations of various treatment modalities, however, are lacking and therapy often remains primarily empiric. Despite this limitation, important strides have been made in the overall management of these patients during the past decade.

ISSN:0257-2753    

DOI:10.1159/000171619

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Although many factors are involved in the pathogenesis of gastroesophageal reflux disease (GERD), the antirefiux barrier at the gastroesophageal junction is the final determinate of reflux. In the majority of cases, transient lower esophageal sphincter (LES) relaxations appear to be the necessary condition for reflux to occur. In severe cases of GERD, especially those with esophagitis, stricture, and Barrett’s epithelium, diminished resting LES pressure plays a contributory role. Esophageal dysmotility may be an additive factor leading to increased esophageal acid contact time and predispose patients to developing erosive esophagitis. Also, delayed gastric emptying may further compromise the LES. Finally, the role of bile reflux across an incompetent gastroduodenal (pyloric) junction remains controversia

ISSN:0257-2753    

DOI:10.1159/000171620

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Antroduodenal manometry is a relatively new technique for the assessment of gastric and small intestinal motor function. The aim of this review is to provide an evaluation of its current status as a diagnostical tool. Available recording systems are reviewed and the study protocol for the evaluation of antroduodenal motor function is described. The role of this methodology in the evaluation of patients with suspected motor disorders, its advantages over other less invasive techniques and limitations are critically assessed. We conclude that, in the evaluation of suspected foregut motor dysfunction, antroduodenal manometry may provide clinically useful information in selected patients; information which may not be available from standard diagnostic tests, including nuclear medicine gastric-emptying studies.

ISSN:0257-2753    

DOI:10.1159/000171621

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

The pathophysiology of defecation disorders is multifactorial. An ideal test should identify the underlying cause(s) and provide guidelines for treatment. Unfortunately, there is no such single test. But several techniques are available that could provide comprehensive information regarding the changes in defecation dynamics. Among these, anorectal manometry offers the most useful test for clinicians. Manometry may provide objective evidence for impaired rectal sensation, poor rectoanal coordination, weak anal sphincters or changes that support a diagnosis of obstructive defecation. Other tests such as the balloon expulsion test may serve as screening tools for patients with constipation. In a patient with fecal incontinence, anal endosonography may localize the sphincter defect and aid surgical reconstruction. The pudendal nerve latency test may provide a pathophysiological basis for a weak anal sphincter. Imaging techniques such as defecography may provide useful information regarding rectal prolapse or levator ani dysfunction. Ideally, the clinician should utilize these tests either to confirm a clinical suspicion or to provide new information that could aid management. This review provides an update regarding the various tests that are available for assessing defecation and provides some practical guidelines for performing manometry.

ISSN:0257-2753    

DOI:10.1159/000171622

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Biofeedback therapy is a useful adjunct to conventional treatment for many patients with refractory defecation disorders. This article provides an overview regarding the historical evolution of this treatment together with current perspectives regarding the principles and techniques of performing biofeedback therapy and an assessment of its outcome in adults and pediatric patients with defecation disorders.

ISSN:0257-2753    

DOI:10.1159/000171623

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

It is the goal of this review to discuss the increasingly common problem of anorectal motility disorders and their potential surgical management. Perhaps the most important goal in patients with anorectal motility disorders is to categorize them accurately into etiologic groups. The reason is that approaches to medical and surgical therapy are highly dependent on accurate categorization of these patients with motility disorders. This review is written from the perspective of a surgical practice which sees a high volume of patients with anorectal motility disorders and has a very logical, nearly algorithmic approach to the evaluation and management of these patients. The review is not exhaustive, nor does it include all possible alternatives. It is meant to be a relatively practical guide to physicians and surgeons who deal with patients with anorectal motility disorders and is based on the experience of surgeons and gastroenterologists who see large numbers of these patients.

ISSN:0257-2753    

DOI:10.1159/000171624

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Constipation is a common condition defined by less than three bowel movements per week. Often constipation is secondary to altered motility of the colon. Tests that measure colonic motility lead the clinician to appropriate therapy. Colonic transit measured with either radionuclides or radio-opaque markers determine whether the transit through the colon is truly slow, and then identify the potential region of the colon that impedes the movement of intraluminal contents. Patients with normal colonic transit do not require further evaluation of their colonic motor function. Colonic and anorectal manometry differentiate patients in to 3 groups: (1) functional anal outlet obstruction; (2) uncoordinated distal colonic phasic contractions, and (3) colonic inertia. Functional outlet obstruction may be treated successfully by increasing the water content of their stools and biofeedback. Antispasmodics including anticholinergics, nitrates and calcium channel blockers may decrease the functional obstruction caused by phasic colonic contractions. The prokinetics such as cisapride have successfully improved constipation due to colonic inertia, Parkinson’s disease or spinal cord injury as well as idiopathic inertia. Occasionally patients with inertia may require colectomy with ileorectal anastomosis to treat severe constipatio

ISSN:0257-2753    

DOI:10.1159/000171625

出版商:S. Karger AG    

年代:1997

数据来源: Karger

摘要:

Drugs affecting gastrointestinal motility have become valuable in the management of a number of diseases. Medications that enhance the transit of material through the gastrointestinal tract are called prokinetics. Although symptom improvement can be seen in a variety of motility disorders, these medications have not shown a selective benefit for a particular motility disturbance or symptom complex. This class of drugs includes several subclasses, each with a distinct mechanism of action. Amongst the existing prokinetic compounds, dopamine antagonists, on the one hand, and cholinomimetic drugs, on the other hand, should be distinguished. Since compounds endowed with dopamine antagonism have the disadvantage of causing neuroendocrine side effects and/or extrapyramidal dyskinetic reactions (seen especially after metoclopramide), the recently developed non-cholinergic non-antidopaminergic compound, cisapride, seems to be the most effective one. Its main mechanism of action is considered to be the stimulation of myenteric cholinergic nerves with consequent increase of acetylcholine release. Recent evidence suggests that blockade of CCK receptors and stimulation of motilin receptors are also promising avenues to increase gastrointestinal motility. Since drugs acting on 5-HT receptors are presently the best available motor-stimulating compounds, new derivatives are being developed as gastrokinetic drugs. Although the long-acting somatostatin analog, octreotide, and the GnRH agonist, leuprolide, have shown prokinetic properties in particular clinical conditions, their widespread use cannot be recommended at present. Further work is needed to determine the predictive value of objective abnormalities for the efficacy of a drug in the individual patient. This is the crucial point to define a rational strategy in clinical practice, especially to establish if functional investigation is needed before a prokinetic drug be given.

ISSN:0257-2753    

DOI:10.1159/000171626

出版商:S. Karger AG    

年代:1997

数据来源: Karger

ISSN:0257-2753    

DOI:10.1159/000171627

出版商:S. Karger AG    

年代:1997

数据来源: Karger