Ezofagomanometry - Causes, symptoms and treatment. MF.
To visualize diseases of the esophagus, visualizing research methods are mandatory. These include esophagoscopy and gastroscopy( FEGDS).But, despite the qualitative examination of the mucous membrane of the organ, these methods can not give complete information about the functioning of the muscles of the esophagus, which are responsible for the proper movement of food into the stomach. Therefore, doctors often resort to such a method of diagnosis as esophagomanometry, or, in other words, to the measurement of pressure in the lumen of the esophagus.
Esophagomanometry is an instrumental examination of the esophagus, consisting in the introduction through the mouth of a water-perfusion catheter that determines the pressure created by its wall and sphincters, and the nature of their peristalsis( successive contractions).
This method is the "gold standard" in the diagnosis of diseases accompanied by impaired motor function of the motor. However, the research method is rather complicated and requires a stationary location of the sensor in the study area, since otherwise the results may be distorted. In addition to water-perfusion catheters, solid-state catheters can be used, but their use is limited by the high cost.
Despite the technical complexity, the information obtained, when properly performed by a qualified specialist, is reliable and plays a significant role in the correct diagnosis of esophageal motility disorders.
Indications.
Ezofagomanometry is prescribed for suspected cases:
- gastroesophageal reflux disease,
- cardiac achalasia,
- diffuse spasm of the esophagus,
- congenital abnormalities of the pharynx,
- postoperative control over the above diseases if there is a need for surgical treatment.
Contraindications.
Esophagomanometry is contraindicated in conditions such as:
- acute infectious diseases, fever,
- chemical burn of the esophagus, acute esophagitis,
- inflammatory process in the diverticulum of the esophagus( diverticulitis), varicose veins of the esophagus with cirrhosis, swelling, and adhesions of the esophagus,
- severe diseases of the internal organs - cardiac, respiratory failure, myocardial infarction, bronchial asthma in the acute stage, acute stroke, etc.,
- mental disorders,
-lkogolnoe intoxication,
- exacerbation of chronic diseases - pancreatitis, cholecystitis and so on.
Preparation for the study.
On the eve of the study, you must exclude food intake 10 hours before the procedure, you should not drink alcohol and smoke. Also it is not recommended to take fat, spicy, spicy food. The liquid can not be taken within three hours before the procedure.
As a rule, the doctor warns the patient that, within 24 hours before the test, he should cancel the medications taken, such as nitroglycerin and its analogs, omeprazole, motilium, theophylline and others, since they can affect the tone of the esophageal muscles.
Carrying out the research.
Ezofagomanometry can be performed both in a polyclinic and in a hospital. After a conversation with a doctor explaining the essence of the procedure, the patient is invited to take a comfortable position sitting in the chair. The doctor performs anesthesia of the oropharynx by irrigation with a solution of lidocaine or dicaine and begins to inject the catheter through the mouth or through the nose. The latter method is preferable, since it significantly reduces discomfort.
After insertion of the catheter into the stomach, the pressure in the lower esophageal sphincter is recorded with the analyzing unit( computer).At this stage, it is important to perform the doctor's commands, for example, to swallow during the insertion of the catheter and hold your breath while pulling the catheter from the stomach higher into the lower sphincter. The patient is then asked to swallow 5 ml of water using a syringe and make a so-called "wet sip".This is repeated three to five times to record several indicators of pressure in the sphincter.
Similarly, as the catheter is pulled up, the pressure without a pharynx is fixed, during a dry pharynx( without water) and during a wet pharynx three to five times. Thus, the pressure is recorded at rest and during the movement of water in the lower sphincter, in several zones along the esophagus and in the upper esophageal sphincter. The catheter is then extracted and all data analyzed by the computer.
The duration of the study is 25-30 minutes, after which the patient is asked to expect results. Unpleasant sensations can arise during the introduction of the catheter in the form of urge to vomit, but they successfully stop, if you calmly and evenly breathe and listen to the doctor's commands. For three to four hours after the procedure, it can be chest sore and coughing that pass on their own.
Explanation of the results of esophagogomanometry.
During the study, data indicative of normal esophageal motility or abnormalities can be obtained. The latter include the absence of peristalsis, uncoordinated motor skills, excessive or inadequate esophagus contractions. In each of the study zones, incomplete relaxation, prolonged or short duration of peristalsis wave, pressure changes, for example, high( above 45 mm Hg) or low( less than 10 mm Hg) resting pressure in the lower esophageal sphincter, and tetc. Only an expert should interpret such results.
Complications.
As a result of a violation of the technique of introducing a catheter, nosebleeds, vomiting, insertion of a catheter into the trachea instead of the esophagus, perforation of the esophagus wall may occur. Due to mechanical stimulation of the vagus nerve, it is possible to develop a reflex response from other organs - spasm of the bronchi, violation of the heart rhythm, loss of consciousness. For the entire history of esophagomanometry, the complications described have occurred in isolated cases.
Doctor therapist Sazykina O.Yu.