Color Atlas of High Resolution Manometry / Edition 1

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While reflux disease, achalasia, esophageal spasm, gastroparesis and IBS include some of the most common disorders in all disease categories, our understanding of their pathophysiology remains elusive. The field of clinical gastrointestinal motility has for decades relied on the measurement of intraluminal pressures to deduce intestinal movements that define these difficult and enigmatic disorders of gut function. Although computers have greatly facilitated the analysis of data obtained from intraluminal pressure recordings, the sensors and catheters used to measure intraluminal pressures have changed little over the last 20 years. In the last 3 years, a new technologic breakthrough has taken place in the evaluation of gastrointestinal motor function. It is called high-resolution manometry. Rather than the old 4 to 8 channel conventional systems used to measure intraluminal pressure, high-resolution catheters employ 36 closely spaced, solid state pressure transducers. This technology enhances the resolution of gut motor activity incredibly. By using color to depict pressure, high-resolution color contours are beautiful images that give a detailed spatial and temporal picture of gastrointestinal motor function that was previously impossible. By recognizing motor patterns, diagnoses can be made that are very difficult, if not impossible, to appreciate with the old technology. High-resolution manometry is a dramatic technical leap in a long time stagnant field.

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Editorial Reviews

Doody's Review Service
Reviewer: Lisbeth A Selby, M.D.(University of Kentucky College of Medicine)
Description: This atlas depicts the standard manometric tracings of motility derangements in a variety of disease states and then presents the corresponding high resolution manometry (HRM) tracings. These comparisons facilitate pattern recognition of HRM. A particular strength of this atlas lies in the detailed illustrations and legends.
Purpose: The purpose is to facilitate pattern recognition with HRM, a relatively new motility diagnostic tool. A book such as this is helpful with HRM increasingly used in many motility labs, and this one is well written and organized. In general, motility evaluation is somewhat abstract and difficult to understand, but this book breaks the process into manageable pieces for those already familiar with low resolution esophageal manometry. I am not sure, however, of the utility of this book for the novice.
Audience: This book would be most useful for persons working closely with gastrointestinal diagnostic motility labs, such as nurses, technicians, and the physicians charged with the interpretation of exams.
Features: HRM features of the esophagus, upper GI tract, and anorectum are covered. The esophageal section surely will be the most relevant at this point since esophageal HRM systems are commonly commercially available. In general, the book is helpful with many detailed color illustrations and clear, concise legends. However, the legends to the graphics are fragmented, which makes them difficult to follow. References are also conspicuously absent.
Assessment: This will be a useful reference for our esophageal motility lab. In its careful and concise explanations of HRM phenomena, it is comparable to a well-known book on standard esophageal motility testing, Esophageal Motility Testing, 2nd edition, Castell and Castell (Appleton & Lange, 1994). Although the sections on upper GI and anorectal HRM are equally well written, with the notable limitation of the format of the legends, these probably will not be as useful since neither is in wide clinical use at this time.
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Product Details

  • ISBN-13: 9780387882925
  • Publisher: Springer US
  • Publication date: 1/23/2009
  • Edition description: 2009
  • Edition number: 1
  • Pages: 90
  • Product dimensions: 6.80 (w) x 9.90 (h) x 0.30 (d)

Table of Contents

Acknowledgement vii

About the Authors ix

1 Introduction to High-Resolution Manometry 1

1.1 High-Resolution Manometry: How Does It Work? 2

2 Esophageal Manometry 11

2.1 Normal High-Resolution Esophageal Manometry 12

2.1.1 Respiratory Variations in the Body of the Esophagus 12

2.1.2 Transition Zone 13

2.1.3 Pressure Inversion Point 15

2.1.4 Lower Esophageal Sphincter 15

2.1.5 Normal Bolus Pressure 16

2.1.6 Peristalsis 17

2.1.7 Gastric Pressures 17

2.2 Abnormal High-Resolution Esophageal Manometry 17

2.2.1 Achalasia 17

2.2.2 Diffuse Esophageal Spasm 25

2.2.3 Nutcracker Esophagus 32

2.2.4 Hiatal Hernia 32

2.2.5 Gastroesophageal Reflux Disease and Lower Esophageal Sphincter 32

2.2.6 Scleroderma 32

2.2.7 Ineffective Esophageal Motility 32

2.2.8 Cricopharyngeal Bar 40

2.2.9 Other Esophageal Observations with High-Resolution Manometry 40

2.3 Troubleshooting in High-Resolution Manometry of the Esophagus 51

2.3.1 Folded Catheter 51

2.3.2 Failed Sensor Bank 51

2.3.3 Air in the Sheath 55

3 Gastric/Small Bowel Manometry 59

3.1 Normal Gastric and Small Bowel High-Resolution Manometry 59

3.1.1 Fasting State 60

3.1.2 Fed State 62

4 Anorectal Manometry 71

4.1 Normal High-Resolution Anorectal Manometry 71

4.1.1 Normal Anal Sphincter 71

4.1.2 Cough Reflex 80

4.1.3 Oscillating Pressure Waves 80

4.1.4 Anoanal Reflex 80

4.1.5 Rectal Response to Balloon Distention 80

4.2 Abnormal High-Resolution Anorectal Manometry 80

4.2.1 Dyssynergic Defecation 80

4.2.2 Hirschsprung's Disease 80

4.2.3 Troubleshooting 88

Index 89

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