Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
What limitations are there to the use of esophageal
manometry?
There are several situations in which esophageal manometry may not
demonstrate the esophageal abnormality that is responsible for a
patient's problem. For example, many patients with GERD have transient (coming
and going infrequently) but prolonged relaxation (minutes rather than seconds)
of the lower sphincter as the cause of their reflux. Such relaxations may be
missed in the short period during which the manometric study is being conducted.
Similarly, if a patient is having infrequent episodes of chest pain due to
esophageal spasm, for example, every few days or weeks, the spasm may not be
seen during a short manometric study. There have been attempts to get around
these problems by using portable equipment and prolonged manometry for two or
more days.
What are the side-effects of esophageal manometry?
Although esophageal manometry is uncomfortable, the procedure is
minimally painful because the nostril through which the tube is
inserted is anesthetized. Once the tube is in place, patients talk
and breathe normally. The side-effects of esophageal manometry are
minor and include mild sore throat,
nosebleeds, and, uncommonly,
sinus problems due to irritation and blockage of the ducts leading
from the sinuses and into the nose. Occasionally, during insertion,
the tube may enter the larynx (voice box) and cause choking. When
this happens, the problem usually is recognized immediately, and the
tube is rapidly removed. Care must be used in passing the tube in
patients who are unable to easily swallow on command because without
a swallow to relax the upper esophageal sphincter the tube often
doesn't enter the esophagus but instead may enter the larynx.
GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid
contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are heartburn,
regurgitation, and nausea. Effective treatment is available for most patients with GERD.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Dyspepsia (indigestion) is a functional disease in which the gastrointestinal organs, primarily the stomach and first part of the small intestine, function abnormally. It is a chronic disease in which the symptoms fluctuate infrequency and intensity. Symptoms of dyspepsia include upper abdominal pain, belching, nausea, vomiting, abdominal bloating, early satiety, and abdominal distention (swelling). These symptoms are most often provoked by eating.
Scleroderma is an autoimmune disease of the connective tissue. It is characterized by the formation of scar tissue (fibrosis) in the skin and organs of the body, leading to thickness and firmness of involved areas. Scleroderma is also referred to as systemic sclerosis, and the cause is unknown. Treatment of scleroderma is directed toward the individual features that are most troubling to the patient.
Dysphagia or difficulty in swallowing, swallowing problems. Dysphagia is due to problems in nerve or muscle control. It is common, for example, after a stroke. Dysphagia compromises nutrition and hydration and may lead to aspiration pneumonia and dehydration.
Esophagitis is caused by an infection or irritation of the esophagus. Infections that cause esophagitis include candida yeast infection of the esophagus as well as herpes.
Achalasia is a disease of the esophagus that mainly affects young adults. Abnormal function of nerves and muscles of the esophagus causes difficulty swallowing and sometimes chest pain.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Acid backing up into the larynx (voice box), it causes reflux laryngitis. Irritation of the lining of the esophagus, larynx, and throat can lead to esophagitis, sinusitis, strictures, hoarseness, throat clearing, swallowing problems, asthma, chronic cough, and more. Typical symptoms of reflux laryngitis include heartburn, hoarseness, or a sensation of a foreign body in the throat. Reflux laryngitis can be treated with OTC medication, prescription medication, and lifestyle changes.
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