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

[Guest guest]

Had a terrific tech. Procedure stinks. And she couldn't get the probe

through the LES, so still don't know the pressure during a swallow. OR

the the resting pressure. But my guess, and she agreed, is that it

*never* relaxes. . . . The end probe was only about 3mm. . . . So that

is a very tiny opening she was trying to thread, blind as it were.

However, it *is* confirmed that there is next to NO movement created

by the esophagus itself. All I have left is gravity. But then, that

was obvious from the barium swallow. . . .

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.

http://www.nature.com/gimo/contents/pt1/full/gimo30.html

<http://www.nature.com/gimo/contents/pt1/full/gimo30.html> Thanks again,

notan!

> >

> > I see your point. I still just can't get over the sense that this is

> > CYA or curiosity. Still not seeing where the manometry decides

anything.

> >

>

> If it is just a matter of achalasia or not achalasia and you trust the

> radiologist to get it right then the barium is often enough. If there

is

> a desire to know what type of achalasia it is, how that type is likely

> to impact the results of treatment, and be sure it is achalasia, then

> the manometry is good.

>

> Doctors make mistakes, radiologist make mistakes. Achalasia is not

among

> the common things seen in radiology. On the other hand, for those

doing

> esophageal motility studies achalasia is the most common motility

> disorder they see. Those doing the motility studies and looking at the

> results could also make mistakes but at least they should be expert at

> achalasia, if they are in a busy esophageal motility center.

>

> notan

>

>

>

>

>

>

[Guest guest]

Yes. I think it is important to remember that surgery does not cure achalasia.

We are still left with it afterwards and a manometry can give doctors important

information needed 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.

[Guest guest]

notan, thanks. Again, lol!

Latest word is that the test was " inconclusive " and that they are *now*

willing to give me meds to help relax the LES. Don't know if they'll

try another manometry after or not, but it seems like relation meds

would make *that* test inconclusive, too, eh?

Just truckin. . . .

> >

> > ... 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

>

>

>

>

[Guest guest]

puddleriver13 wrote:

>

> Latest word is that the test was " inconclusive " ...

>

Inconclusive that it is achalasia maybe, but it seem conclusive that

there is some motility problem.

> Don't know if they'll try another manometry after or not, but it

> seems like relaxation meds would make *that* test inconclusive, too, eh?

>

To my knowledge there are no standards for interpreting a test that was

done under medications that relax the esophageal muscles. For that

reason some doctors will refuse to do it under that condition. Other

doctors are known to put patients completely under. If I had it done

with the medications I would want it interpreted by someone that has

done others that way. They may have you stop your medication for some

time before the test and then put you under to place the probe

laparoscopically.

I am curious which medication they gave you. An all day one or a before

eating one? Most of these can lower blood pressure. The before eating

ones are usually stronger and may take some getting used to.

notan

[Guest guest]

I asked for a nitrate, they offered a Calcium Channel Blocker (which I'm

allergic to -- pedal edema of a very bad variety. I'm still coping with the mess

they created while I was in the hospital.) I know, because I've tried it, that

Viagra gives me a clear five hour window to be able to eat, so I'm projecting

that it does relax the LES. However, I'm down to my last pill, and am saving it

for an emergency, lol!

At any rate, I have another appointment on Thursday. Hoping I can get some

sanity to prevail here.

I am curious which medication they gave you. An all day one or a before

> eating one? Most of these can lower blood pressure. The before eating

> ones are usually stronger and may take some getting used to.

>

> notan