Role of stationary esophageal manometry in clinical practice. Manometric results in patients with gastroesophageal reflux, dysphagia or non-cardiac chest pain.

The present study was carried out to evaluate the diagnostic usefulness of stationary esophageal manometry in 263 patients divided into three groups: 150 patients with reflux symptoms, 68 with dysphagia, and 45 with non-cardiac chest pain. Patients with endoscopic abnormalities were excluded. Standard manometry was performed following the station pull-through technique. In the group of patients with reflux symptoms 40.7% had a normal manometry and 57.3% had abnormalities, being the most frequent (43%) hypotensive lower esophageal sphincter. In the dysphagia group, 20.6% of manometries were normal and 79.4% were abnormal, of which achalasia was the most frequent disorder (53.7%). In the case of non-cardiac chest pain, 42.2% of patients had a normal manometry and 57.8% an abnormal one, of which hypotensive lower esophageal sphincter was the most frequent abnormality. A significant higher proportion of manometric alterations were found in the dysphagia group compared to reflux symptoms and non-cardiac chest pain (p < 0.05). No statistical differences were found between the reflux and the non-cardiac chest pain groups. Manometry yields a higher diagnostic value in patients with dysphagia, and therefore manometry should be performed routinely after the exclusion of any organic esophageal disease. Manometry is not a first-choice functional diagnostic test in the study of patirnts with gastroesophageal reflux or non-cardiac chest pain.

Sedación en endoscopia digestiva. Análisis de la tolerancia y de las complicaciones / Sedation for gastrointestinal endoscopy. Analysis of tolerance and complications

Objetivo: analizar la tolerancia y las complicaciones en pacientes a los que se realizó endoscopia digestiva. Pacientes y métodos: se han estudiado prospectivamente 143 pacientes: al 44,8 por ciento se practicó una endoscopia alta diagnóstica, al 13,3 por ciento, endoscopia alta terapéutica, al 37 por ciento colonoscopia diagnóstica y al 4,9 por ciento colonoscopia terapéutica. Se utilizó midazolam o midazolam y meperidina. Se analizaron la dosis utilizada, la tolerancia subjetiva, el nivel de sedación y las complicaciones. Para el análisis estadístico se utilizó la prueba de Chi cuadrado y el test de comparación de proporciones, siendo los valores de p 40 años. El principal problema es la desaturación que aumenta en las endoscopias terapéuticas (AU)

Sedation for gastrointestinal endoscopy. Analysis of tolerance and complications.

OBJECTIVE: To analyse tolerance and complications in patients undergoing a gastrointestinal endoscopy. PATIENTS AND METHODS: One hundred forty three patients were prospectively studied: 44.8% underwent a diagnostic upper endoscopy; 13.3%, a therapeutic upper endoscopy; 37%, a diagnostic colonoscopy and 4.9%, a therapeutic colonoscopy. Midazolam or midazolam combined with meperidine were used. Tolerance, level of sedation and complications were studied. Chis quare and ratio comparison tests were used for the statistical analysis. P-values less than 0.05 were considered as statistically significant. RESULTS: In the diagnostic upper endoscopy group, tolerance was better with midazolam plus meperidine vs midazolam only (83.8% and 59.3% respectively); p < 0.05. In the therapeutic upper endoscopy group, tolerance was also better when both drugs were combined; p < 0.05. In the diagnostic and therapeutic colonoscopy groups, tolerance was good in 63.5% and 85.7% of patients, respectively. Men had better tolerance for upper endoscopy; p < 0.05. Tolerance was worse in patients under 40 years of age for upper endoscopy; p < 0.05. Mild desaturation occur in 27.3% of patients, being more severe in therapeutic procedures; p < 0.05. CONCLUSIONS: Tolerance was good in a high percentage of patients, and better in men and in patients older than 40 years of age. The main problem is desaturation, that increases in therapeutic procedures.