Re: Re: Question: Manometry -- How the test went. . . .

[Guest guest]

wrote:

>

> ... couldn't get the probe through the LES,

>

While that is not an exact measure it does indicate that the pressure

was enough to block the probe. I would guess that means that there was

significant pressure at the LES.

> ... But my guess, and she agreed, is that it *never* relaxes. . . .

>

At least not while she was trying to get the probe though it. And I

would guess she had you swallow to try and relax it so the probe would

go through, which would indicate it wasn't relaxing in response to swallows.

> ..., it *is* confirmed that there is next to NO movement created by

> the esophagus itself. All I have left is gravity.

>

I am guessing that there were no strong spasms detected in the

esophageal body.

> Again: why this test was necessary continues to escape me. . . .

>

> This from the literature:

>

> Esophageal manometry remains the gold standard for the assessment of

> esophageal motor activity. However, it is not a primary investigation

> and should be performed only when the diagnosis has not been achieved

> by careful history, barium radiology, or endoscopy.

>

Lets take a look again at:

Current clinical approach to achalasia.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2731945/

Here is a quote in reference to balloon dilation:

" Predictors of treatment failure with balloon dilation appear to be ...

Manometric findings that predict poor outcome are high initial LES

pressures (e.g. > 15-30 mmHg) or a reduction of LES pressure < 50% after

the first dilation. Manometry should, therefore, be routinely performed

pre- and post-interventionally. "

Here is a quote in reference to myotomy:

" Predictors of a negative outcome with surgical myotomy were ..., lower

preoperative LES pressures of < 30-35 mmHg, ... "

Notice that low LES pressure is good for dilatation and high LES

pressure is good for myotomy. I think, based on the trouble getting the

probe through your LES that maybe you are on the high end for LES

pressure. So, maybe myotomy is the better guess, but only a guess.

Here is a quote in reference to any treatment:

" ... type I exhibiting minimal esophageal contractility without

pressurization, type II with absent peristalsis but compartmentalized,

pan-esophageal pressurization, and type III with lumen obliterating

spasm. The authors showed that pan-esophageal pressurization (type II)

had the best overall treatment response, whereas type III predicted a

poor treatment response to all types of therapy. ... "

Assuming there were no strong spasms closing off the esophageal body

found in the test, you are not type III, which maybe is good news for

treatment.

Now, as with almost all things dealing with achalasia, not all experts

agree with any of this. Even so, maybe there is more to learn, or at

least consider, from your manometry test than you thought.

notan