Radu Tutuian, Donald O Castell

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Presentation transcript:

Rumination documented by using combined multichannel intraluminal impedance and manometry Radu Tutuian, Donald O Castell Clinical Gastroenterology and Hepatology Volume 2, Issue 4, Pages 340-343 (April 2004) DOI: 10.1016/S1542-3565(04)00065-5

Figure 1 Ambulatory distal esophageal and intragastric pH monitoring on therapy indicating negative association of regurgitation and acid gastroesophageal reflux. There was also a decrease in frequency of symptoms 1 hour after the meal. Clinical Gastroenterology and Hepatology 2004 2, 340-343DOI: (10.1016/S1542-3565(04)00065-5)

Figure 2 Nine-channel EFT probe positioned with distal transducer in the lower esophageal sphincter (LES). The catheter contains 4 impedance measuring segments (Z-1 through Z-4) each 5 cm apart and 5 pressure transducers each 5 cm apart. P1, P2, and P3 are unidirectional solid-state transducers; P4 and P5 are circumferential solid-state transducers. The distal transducer is placed in the stomach, and the second most distal (P4) is placed in the LES high-pressure zone. Impedance measuring segments and pressure transducer are located at 5, 10, and 15 cm above LES. Clinical Gastroenterology and Hepatology 2004 2, 340-343DOI: (10.1016/S1542-3565(04)00065-5)

Figure 3 Combined MII-EM tracings showing the sequence of events preceding the regurgitation symptoms. An increase in intra-abdominal pressure identified in the pressure transducer located in the stomach initiates the reflux event identified by both impedance changes as well as common cavity phenomena. Peristaltic fore contractions clear the intraesophageal content. All events happened briefly before the patient indicates regurgitation. Clinical Gastroenterology and Hepatology 2004 2, 340-343DOI: (10.1016/S1542-3565(04)00065-5)

Figure 4 Combined MII-EM identified reflux during transient lower esophageal sphincter relaxation. MII (top 4 channels) identified reflux episode without common cavity phenomena and not preceded by increase in intra-abdominal or intraesophageal pressure (manometry in bottom 5 channels). Clinical Gastroenterology and Hepatology 2004 2, 340-343DOI: (10.1016/S1542-3565(04)00065-5)