Multiple Rapid Swallow Responses During Esophageal High-Resolution Manometry Reflect Esophageal Body Peristaltic Reserve
These two high-trained and experienced physicians will be in private practice and will perform procedures at Cape Regional Medical Centers Same Day Surgery Care Center, according to a prepared statement from Cape Regional. Cape May County has a demonstrated need for additional gastroenterology services, stated William Hofmann, D.O., outpatient medical director of Cape Regional Physicians Associates. We are excited to have Dr. Masciarelli and Dr. Vattasseril join Cape Regional Health System. Masciarelli is a graduate of the University of Medicine and Dentistry of New Jersey (UMDNJ), School of Osteopathic Medicine in Stratford. He earned his bachelors of science degree from St. Josephs University, Philadelphia. His postgraduate training includes a fellowship and residency in Gastroenterology at Kennedy Health System. Masciarelli has been in private practice for the past 21 years, most recently with Advanced Gastrointestinal Specialists and has served as Chief Gastroenterologist at Kennedy Health System in Washington Township from 2006 to 2012. Vattasseril is a graduate of the University of Debrecen Medical Health and Sciences Center in Debrecen, Hungary, where he graduated cum laude. His postgraduate training includes a fellowship and residency in gastroenterology at New York Methodist Hospital in Brooklyn, where he was named chief resident. Vattasseril most recently served as attending physician, gastroenterology at Memorial Hospital of Salem County. Appointments are now being scheduled for both doctors, according to information from the heath center. To schedule an appointment, call 609-536-8010. Their new office will be located at Cape Regional Medical Commons, 211 N.
Prakash Gyawali, Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri 63110, USA. E-mail: firstname.lastname@example.org Presented in preliminary form at the annual meeting of the American Gastroenterological Association, San Diego, 2012. Received 23April2013; Accepted 30July2013 Advance online publication 10September2013 OBJECTIVES: Dysphagia may develop following antireflux surgery as a consequence of poor esophageal peristaltic reserve. We hypothesized that suboptimal contraction response following multiple rapid swallows (MRS) could be associated with chronic transit symptoms following antireflux surgery. METHODS: Wet swallow and MRS responses on esophageal high-resolution manometry (HRM) were characterized collectively in the esophageal body (distal contractile integral (DCI)), and individually in each smooth muscle contraction segment (S2 and S3 amplitudes) in 63 patients undergoing antireflux surgery and in 18 healthy controls. Dysphagia was assessed using symptom questionnaires. The MRS/wet swallow ratios were calculated for S2 and S3 peak amplitudes and DCI. MRS responses were compared in patients with and without late postoperative dysphagia following antireflux surgery. RESULTS: Augmentation of smooth muscle contraction (MRS/wet swallow ratios >1.0) as measured collectively by DCI was seen in only 11.1% with late postoperative dysphagia, compared with 63.6% in those with no dysphagia and 78.1% in controls (P0.02 for each comparison). Similar results were seen with S3 but not S2 peak amplitude ratios. Receiver operating characteristics identified a DCI MRS/wet swallow ratio threshold of 0.85 in segregating patients with late postoperative dysphagia from those with no postoperative dysphagia with a sensitivity of 0.67 and specificity of 0.64. CONCLUSIONS: Lack of augmentation of smooth muscle contraction following MRS is associated with late postoperative dysphagia following antireflux surgery, suggesting that MRS responses could assess esophageal smooth muscle peristaltic reserve.
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