ABSTRACT
INTRODUCTION: High-resolution esophageal manometry (HREM) is a technique to determine the pressure pattern which is a function of esophageal musculature and integrity of LES. The indications for HREM evaluation include evaluation of nonobstructive dysphagia, symptoms of regurgitation and noncardiac or atypical chest pain unexplained by endoscopic evaluation To analyse profile of esophageal motility disorders in patient presenting with refractoryAIM: gastroesophageal reflux disease (GERD), dysphagia and atypical chest pain in tertiary care centre in Western India METHODS: We enrolled patient presented with refractory GERD, dysphagia and atypical chest pain from Jan 2020 to March 2022 at Department of gastroenterology, National Institute of Medical College & R, Jaipur. Upper GI endoscopy and high-resolution esophageal manometry was done in all patients Ineffective esophageal peristalsis,RESULTS: achalasia cardia, hypercontractile esophagus, fragmented peristalsis and esophagogastric junction outflow obstruction were common diagnosis made by high resolution esophageal manometry In our study ineffectiveConclusion: esophageal motility most common and achalasia cardia second most common diagnosis identified on esophageal manometry
ABSTRACT
Doença do refluxo gastroesofágico é uma condição que ocorre quando o refluxo do conteúdo gástrico causa sintomas ou complicações. O tratamento compreende medidas comportamentais e terapia farmacológica. A maioria dos pacientes responde bem aos inibidores de bomba protônica, mas 20% a 42% podem não responder tão bem. Alguns pacientes têm tratamento difícil e podem ter a chamada GERD refratária. As principais causas são: pirose funcional, falta de aderência ao tratamento, erro de prescrição, diferenças genotípicas, refluxo gastroesofágico não ácido, doenças autoimunes, esofagite eosinofílica e erro diagnóstico.
ABSTRACT
Approximately 25% of patients with typical gastroesophageal disease (GERD) symptoms do not respond to double dose of proton pump inhibitors (PPI), and might have refractory GERD. The causes of refractory GERD include poor compliance, esophageal motility disorder, duodeno-gastroesophageal reflux, eosinophilic esophagitis, nonacid reflux, functional heartburn, and inadequate acid suppression. when patient compliacne have been confirmed, it is reasonable to escalate to twice dose of PPI. Upper gastrointestinal endoscopy should be performed to rule out other disorders such as esophageal esophagitis, pill induced esophagitis, or esophageal involvement of autoimmune disorders. If symptoms persist despite double dose PPI, 24 hr pH-impedance monitoring, esophageal manometry, and scintigraphic gastric emptying scan may be required.