Method for the diagnosis of motor function of the esophagus

 

The invention relates to medicine, namely to a gastroenterologist, and can be used both for adults and for children of school age. The method includes recording areas of the esophagus with the values of the impedance below the threshold of detection of gastroesophageal reflux (GER) and indices of motor function. By reducing the impedance in any zone relative to the threshold is taken as 100%, diagnose lowering the tone of the esophagus, when the value of the impedance from 100% to 200% of normal tone, above 200% - increased tone. Build the graph, the abscissa of which represents the time of the study, the y-axis is the distance relative to the level of the lower esophageal sphincter. Put on it the characteristics of the tone in each area of study in unit time, bringing in Hypo-, normo-and hypertensive area and designating a different color. In hypertensive sections define the indicator berteroi function of the esophagus (BF) on a 4-point system, with the first digit after BF reflects the duration of hypertonic contractions of the esophagus and is 3 points, with the duration of hypertension, at least 90% of the time of the study, 2 points in duration from 40 to 90%, 1 point - if the duration is not greater than 40%, 0 points - Neal 3 points in the distribution areas of hypertension more than 7 cm, 2 points - 4-7 cm, 1 point - no more than 4 cm, 0 points - no. When BF23, BF32, BF33 diagnosed with severe hypertension dyskinesia of esophagus, BF13, BF22, BF31 - moderate, BF11, BF12, BF21 - easy form. In hypotonic plots a graph on a 4-point system to determine the indicator of isolated remnants of refluxate (RR) and indicator species reflux (RT), characterizing the degree of hypotension distal esophagus. The first digit after the RR reflects the duration of the delay evacuation of refluxate and is 3 points for the duration of hypotonic plots not less than 25% of the time of the study, 2 points from 10 to 25%, 1 point - no more than 10% of the time study 0 points - no. The second digit is a quantitative assessment of the magnitude of residues of refluxate in hypotonic parts of the esophagus and is 3 points for areas greater than 6 cm, 2 points from 3 to 6 cm, 1 point - no more than 3 cm, 0 points - no. When RR23, RR32, RR33 diagnosed with severe hypotonic dyskinesia of esophagus, RR13, RR22, RR31 - moderate, RR11, RR12, RR21 - easy form. The first digit after RT reflects the duration of GERD and is 3 points for the duration of hypotension at least 90% of the time of the study, 2 points from 40 to 90%, 1 point is not higher than 40%, 0 points - no. The second digit after RT is the quantities cm, 1 point - less than 6.5 cm, 0 points - no. When RT23, RT32, RT33 diagnose cardia insufficiency severe, RT13, RT22, RT31 - medium, RT11, RT12, RT21 - mild. The method improves the accuracy of diagnosis of motor function of the esophagus due to determine the severity of his Hypo - and hypertonicity, qualitative assessment of the strength, the incidence and duration of tonic contractions, the interaction of the various departments of the esophagus. 8 tab., 2 Il.

The invention relates to medicine, namely to a gastroenterologist, and can be used in gastroenterology hospitals, clinics, diagnostic centers, both for adults and for children of school age.

Known methods of diagnostics of motor function of the esophagus.

1. Radiographic diagnosis

X-ray method gives a holistic view of the esophagus that allows the study of the shape of the body position, tone the muscular wall and peristalsis. The most important x-ray diagnosis of gastroesophageal reflux (GER), reflexitivity, hernia hiatal, this takes place prepositional rentgenska ostalnom position on the emergence of a radiopaque substance into the esophagus. In patients with clear clinical signs of reflux disease and complications of GER x-ray yields positive results in 86% of cases[2, 3, 4, 6, 18]. Dyskinesia of esophagus accompanied by violation of tone and peristalsis: hypotonia of the esophagus or spasms in a variety of spastic deformities (like a corkscrew, clear, saws, beads and other), antiperistaltic contractions. There are two major forms of dyskinesia of esophagus: hypertonic-hyperkinetic (hyperkinesia) and hypotonic-hypokinetic (hypokinesia) [8].

The lack of x-ray method is that it limits the ability to study motor function due to the danger of radiation damage.

2. Endoscopic method

For successful diagnosis of various diseases by esophagoscopy should examine not only the integrity of the mucous membrane, its color, mobility, folding, and function of the esophagus is a change in its walls, depending on the breathing and heart rate, the presence of rigidity of the walls, not deal with the introduction of air.

Endoscopic method study of the esophagus allows you to identify and establish the severity of reflux esophagitis, odnogolosy diaphragm can see a gaping cardio and throwing gastric contents into the esophagus, circular polarisavenue mucous membrane of the stomach into the esophagus, partial fixation prolabium complex. The discrepancy between the x-ray and endoscopic methods for the detection of GERD is often caused, on the one hand, the bulk viscosity of the barium suspension compared to gastric contents could prevent regurgitation, on the other hand - receiving barium suspension increases the filling of the stomach and creates conditions for the emergence of regurgitation. According to modern researchers, esophagoscopy diagnostically insignificant, if necessary, identify GER. Gagging during endoscopic investigations sometimes lead to displacement of cardia of the stomach into the esophagus, which increases the risk of overdiagnosing.

However, the incidence of GER in x-ray and endoscopic examination about the same and is 47-60%. The main applications of esophagoscopy - identification of esophagitis and treatment of stricture of the esophagus associated with GER.

The disadvantages of this method are the difficulty of mapping the received data, its invasiveness and high cost[1, 2, 7, 10, 11].

3. Oesophageal manometry

The study of lower food is th length of the lower esophageal sphincter (usually 2-5 cm), the length of the abdominal part (usually 1-5 cm), the average level of the basal pressure (normal 14,3-34,5 mm). Recorded periods of transient relaxation unrelated to swallowing (relaxation of the sphincter lasting more than 10 s), evaluates the ability of the sphincter to relax during swallowing[11, 12, 14, 15, 19].

The disadvantage is the discomfort for the patient, the complexity and high cost.

4. Daily monitoring of pH in the lower third of the esophagus

Daily intraesophageal pH monitoring identifies episodes of reflux in the distal esophagus, as evidenced by the decrease of pH below 4. Registers the total number of reflux, the number of episodes lasting more than 5 min, the duration of the great episode, the average duration of reflux, the total time of the study, during which the pH was below 4 [2, 4, 13, 16, 17].

The disadvantage of this method is the need for x-ray or gauge control of the probe position, the impossibility of simultaneous study of different parts of the esophagus, the high cost of equipment for daily monitoring of pH.

On the closest to the technical essence and the achieved effect as a prototype we have chosen impedance the sa (AR), the local speed of esophageal clearance (CL), the height of the reflux (HR).

Research methodology the motor function of the esophagus by way of a prototype based on registration intraesophageal impedance when the reflux of gastric contents into the esophagus and decides the private task of diagnosis of gastroesophageal reflux (GER). By the way-the original prototype probe is inserted into the stomach and determine intragastric acidity in the basal phase secretion, after which the probe is withdrawn from the stomach and install it into the esophagus so that the distal end of the probe was located above the esophago-gastric junction. Then register intraesophageal impedance in eight zones and the time during which the magnitude of the impedance does not exceed the threshold value (100 Ohms), the formula determines the aggressiveness of reflux (AR); speed local esophageal clearance (CL) and the height of the reflux (HR). When values of AR>10% diagnose pathological gastroesophageal reflux, and when values of CL<10% detect a violation of esophageal clearance.

Because the prototype is focused on the diagnosis of gastroesophageal reflux, it does not take into account the whole range of detected values of the impedance (from 0 to 300 Ohms), which does not allow assessing what their changes intraesophageal impedance, by which to judge the functional interaction of different parts of the esophagus in norm and pathology.

The objective of the invention is to develop a method that improves the efficiency of diagnosis of motor function of the esophagus, due to determine the severity of his Hypo - and hypertonicity.

The problem is solved in that the set of impedance probe above the esophago-gastric junction 2-3 cm, register intraesophageal impedance in several areas throughout the esophagus, determine the parts of the esophagus with the values of the impedance below the threshold of detection of gastroesophageal reflux (GER) and indices of motor function. At lower intraesophageal impedance in any study area relative to the threshold value, taken as 100%, diagnose lowering the tone of the esophagus, when the value of the impedance from 100 to 200% of normal tone, but values above 200% - increased tone. Then build a graph esophagoenterostomy, the abscissa of which represents the time of the study, the y-axis is the distance relative to the level of the lower esophageal sphincter. On the schedule for the cause of the established characteristics of the tone in each area of study in unit time, which GW function (BF), the amount of isolated remnants of refluxate (RR), type reflux (RT). The index BF the first number after the name is a quantitative estimate of the duration of hypertonic contractions of the esophagus on a 4-point system: three points for duration of hypertension is at least 90% of the time of the study, two points for the duration of hypertension ranges from 40 to 90% of the time of the study, one point is the duration of hypertension does not exceed 40% of the research time, zero points do not. The second digit after the name of the index is a quantitative assessment of the prevalence zones hypertonic contractions on a 4-point system: three points - zone hypertension are greater than 7 cm, two points zone hypertension apply to 4-7 cm, one point - spread zones hypertension does not exceed 4 cm, zero points do not. When the values BF23, BF32, BF33 diagnosed with severe hypertension dyskinesia of esophagus, when the values BF13, BF22, BF31 - moderate form, when values of the BF11, BF12, BF21 - easy form. The indicator RR the first number after the name is a quantitative estimate of the duration of delay evacuation of the remnants of refluxate in hypotonic parts of the esophagus on a 4-point system: three points for a duration of refluxate from 10 to 25% of the time of the study, one point - the duration of the preservation of the remnants of refluxate not more than 10% of the time of the study, a score of zero does not. The second number after the name is a quantitative assessment of the magnitude of residues of refluxate in hypotonic parts of the esophagus on a 4-point system: three points - the average size of the remnant of refluxate more than 6 cm, two points - the size of the balance of refluxate size from 3 to 6 cm, one point - no more than 3 cm, zero points do not. When the values RR23, RR32, RR33 diagnosed with severe hypotonic dyskinesia of esophagus, when the values RR13, RR22, RR31 - moderate form, when the values RR11, RR12, RR21 - easy form. At the rate RT, the first number after the name is a quantitative estimate of the duration of GER on a 4-point system: three points - GER duration is not less than 90% of the time of the study, two points for the duration of GER is from 40 to 90% of the time of the study, one point does not exceed 40% of the research time, zero points do not. The second number after the name is a quantitative estimate of the height of GER on a 4-point system: three points - GER than 11 cm, two points - GER from 6.5 to 11 cm, one point - GER of less than 6.5 cm, zero points - no, when values of RT23, RT32, RT33 diagnose cardia insufficiency severe, when nachenaetsya as follows.

Impedance metric study of motor function of the esophagus is performed on an empty stomach with neogastropoda RGG-01 and the impedance of intragastric probe G (or G) according to the method of the prototype [5]. After 5 min after installation of the probe in the esophagus (time to adapt) starts the measurement of the impedance in eight research areas of the esophagus. The study must be at least 20 minutes

It is known that the scalar impedance of the biological object (impedance) is composed of the ohmic (active) resistance due to ionic conductivity and capacitive (reactive) resistance and is expressed mathematically as follows:

where Z is the impedance of the biological object;

R is the ohmic resistance;

XC is capacitive reactance.

To mitigate capacitive component (XC) on the results of the impedance measurement is carried out by low-frequency current (10 kHz). Therefore, the value of intraesophageal impedance, basically, will be presented to the resistive component of intracavitary medium (ZR), i.e.:

where

S is the cross-sectional area intraesophageal environment.

Motor function of the esophagus is accompanied by a change in its lumen, which leads to a change in cross-sectional area (S) between the walls of the esophagus and izmeritelnie electrodes. Values intraesophageal impedance (Z) are inversely proportional to the cross-sectional area [9].

Since the distance between the electrodes of the probe constant (l=const), the size of the intragastric impedance (Z) will be determined electrolyte composition esophageal secret () and the geometrical dimensions of the environment (S) concluded between the electrodes of the probe and the mucous membrane of the esophagus.

To exclude the effects of conductivity intraesophageal environment and design features of the impedance probe on the results of the analysis of motor function of the esophagus (MFP) we used a relative measurement method:

where Zi is the value of the low-frequency impedance at i - time;

Zo - value threshold impedance at check-GER;

- the value of electrical resistivity intraesophageal environment;

Si is the area of the cross the Oia intraesophageal environment, above which is registered GER.

Thus, the value of the MFP characterizes the change intraesophageal space Si, which depends on the state of muscle tone of the esophagus. With respect to the probes series G the threshold value Zo is equal to 100 Ohms, so the formula to calculate the MFP acquires the following form:

MFP=Zi(%).

When a dense abimanyu probe walls of the esophagus, the thickness of the conductive layer is extremely small and the magnitude of the MFP usually exceed 200%. This situation can occur when the contact electrodes of the probe in the area of the lower esophageal sphincter. Therefore, the MFP>200% reflects the state of hypertonicity of the esophagus. When the reflux of gastric contents into the esophagus the magnitude of the impedance drops below 100 Ohm [5], in this case, the value of the MFP does not exceed 100%, which indicates a weakening of the muscle tone of the walls of the esophagus and cardia insufficiency. Our extensive research has shown that in healthy human value intraesophageal impedance range from 100 to 200 Ohms, corresponding to values of the MFP 100 to 200%.

Data analysis impedance metric studies of motor function of the esophagus is carried out on the contour think the level of the lower esophageal sphincter (Les). On the chart put the values of the MFP in each area of study in unit time, which are combined in Hypo-, normo-and hypertensive region and represent different colors respectively to the intervals of values of the MFP: 0-99%, 100-199% 200-299% (Fig.1). If necessary, the number of intervals of the MFP can be increased. The resulting graph esophagoenterostomy allows to monitor the state of intraesophageal space in three-dimensional format: tone, distance and time of the esophagus.

To assess motor function of the esophagus according to esophagoenterostomy we have developed a series of visual analogue indicators: barrier function (barrier function - BF), the remains of refluxate (reflux remainders - RR), type reflux (reflux type - RT). The proposed alphanumeric encoding of these indicators, where the letters correspond to the indicator, the figures show that the zone settings tonic contractions of the esophagus. To understand the coding system of Fig.2 presents a schematic representation of stylized fragments graphs MFP.

Barrier function (barrier function - BF) of the esophagus characterized by the severity of hypertensive contractions (MFP>200%). The first number after the name of the index is a quantitative assessment of the products is not less than 90% of the time of the study (monotone); two points for the duration of hypertension ranges from 40 to 90% of the time of the study (monotone discrete); one point is the duration of hypertension does not exceed 40% of the research time (discrete); zero points do not. The second digit after the name of the index is a quantitative assessment of the prevalence zones hypertonic contractions on a 4-point system: three points - zone hypertension are greater than 7 cm, Fig.2 marked BFx3 (diffuse); two points - zone hypertension apply to 4-7 cm, Fig.2 marked BFx2 (diffuse-focal); one point - spread zones hypertension does not exceed 4 cm in Fig.2 marked BFx1 (alopecia); zero points do not. When the values BF23, BF32, BF33 diagnosed with severe hypertension dyskinesia of esophagus, when the values BF13, BF22, BF31 - moderate form, when values of the BF11, BF12, BF21 - easy form.

The remains of refluxate (reflax remainders - RR) is a measure of the presence of isolated hypotonic plots (GIF<100%) in the proximal esophagus, causing violation of the full evacuation of refluxate. The first number after the name of the indicator is a quantitative estimate of the duration of delay evacuation of the remnants of refluxate in hypotonic plot the surveys; two points for the duration of the preservation of the remnants of refluxate from 10 to 25% of the time of the study; one point - the duration of the preservation of the remnants of refluxate not more than 10% of research time; zero points do not. The second digit after the name of the index is a quantitative assessment of the magnitude of residues of refluxate in hypotonic parts of the esophagus on a 4-point system: three points - the average size of the remnant of refluxate more than 6 cm; two units - the size of the balance of refluxate size from 3 to 6 cm; one point - no more than 3 cm; zero points do not. In the absence of residues of refluxate in the esophagus, this figure is equal to RR00. When the values RR23, RR32, RR33 diagnosed with severe hypotonic dyskinesia of esophagus, when the values RR13, RR22, RR31 - moderate form, when the values RR11, RR12, RR21 - easy form. In Fig.2 shows a stylized examples of dimensions RR for conditional observation time.

Type reflux (reflux type - RT) is a measure of the degree of hypotension distal esophagus (GIF<100%) on esophagoenterostomy. The first number after the name of the indicator is a quantitative estimate of the duration of GER on a 4-point system: three points - GER duration is not less than 90% of the time of the study; two units - long life & energy saving the points no. The second digit after the name of the index is a quantitative assessment of the height GER on a 4-point system: three points - GER than 11 cm (registered above the sixth zone survey), Fig.2 marked RTx3; two points - GER from 6.5 to 11 cm (recorded at the height from the third to the sixth zone survey), Fig.2 marked RTx2; one point - GER of less than 6.5 cm (registered no higher than the third zone survey), Fig.2 marked RTx; zero points do not. In the absence of failure of the cardia and GER the ratio of RT00. When the values RT23, RT32, RT33 diagnose cardia insufficiency is severe, when the values RT13, RT22, RT31 - cardia insufficiency moderate, with values RT11, RT12, RT21 - mild.

Consider the example of a contour esophagoenterostomy shown in Fig.1. As can be seen from the graph, we investigated the patient has two episodes of GER of different height and length. The first episode of high GER approximately 30 ended with a short rising tone in the lower esophagus, which contributed to cleanse him from refluxate. The second is a longer episode GER pointed to a severe failure of the cardia, protective reaction of the esophagus appeared as the second function of the esophagus can be expressed by the indicators BF22, RR00, RT33.

In our opinion, a symptom of retrosternal pain in patients with GERD can be caused by severe hypertensive dyskinesia of esophagus, and the sensation of heartburn is the presence of large remnants of refluxate in the proximal esophagus due to hypotonic dyskinesia of esophagus and/or failure of the cardia.

Clinical example 1

Patient L., age 16, case history No. 4697

This patient was treated in the gastroenterological Department of DGIB No. 3 with 13.11.00 on 05.12.00 with a diagnosis of Gastroesophageal reflux disease. Superficial reflux esophagitis. Axial hernia hiatal. Chronic gastroduodenitis (common surface) with high acid-forming function of the stomach, associated with Helicobacter infection in the acute phase. Concomitant diagnosis: Atopic dermatitis. Neurocirculatory dysfunction.

Was admitted with complaints of epigastric pain, in the chest, stomach and around the navel arising before eating and physical activity, and expressed diarrhoeal disorders: nausea on an empty stomach, belching air, bitter taste in the mouth, vomiting after eating. Sick about five years. History of chronic tonsillectomy cholecystitis.

An objective examination of the patient revealed multiple traits undifferentiated connective tissue dysplasia, neurocirculatory disorders, atopic dermatitis, tenderness in the epigastrium. X-ray examination of the esophagus was diagnosed with non-fixed axial hernia hiatal, gastroesophageal reflux. When fibrogastroduodenoscopy found the following changes: superficial reflux esophagitis, cardia insufficiency, superficial common gastro. Urease test with biopsies from antrum positive.

The results of impedance metric studies of motor function of the esophagus of the prototype and the present method when entering a patient in the hospital at the stage of diagnosis are presented in table 1.

The results of the study on prototype-based acid-forming function of the stomach and the amount of refluxate indicate a physiological nature GER (AR<10%) at a moderate height and preservation of esophageal clearance.

By the present method there have been several short-and medium is the totype not contradict each other.

Further information: the patient was observed uniformly discrete and diffuse-focal nature of the barrier function of the proximal esophagus (BF22); residues of refluxate in the proximal failed to fix (RR00). Values MFP allow us to conclude about the temperate nature of the GER and compensatory response of the barrier function of the esophagus. Annex 1 presents a fragment of the plot MFP sick.

Clinical example 2

Patient I., 13.odd, the case history No. 5277

The patient was treated in the gastroenterological Department of DGIB No. 3 with 28.11.01 on 15.12.01 with a diagnosis of Gastroesophageal reflux disease without esophagitis. Chronic gastroduodenitis (surface common gastritis, erosive Bulba) associated with Helicobacter infection, with increased acid-forming function of the stomach, in the acute phase. Biliary dyskinesia. Etc. Concomitant diagnosis of Giardiasis. Ascariasis.

Was admitted with complaints of pains in the epigastrium, under the xiphoid process of the sternum, in the right and left podrebarac. It was noted denominated diarrhoeal disorders: nausea on an empty stomach, belching air and eaten food, sour p is ries, enterobiasis. Heredity burdened by peptic ulcer, chronic cholecystitis.

An objective examination of the patient revealed multiple traits undifferentiated connective tissue dysplasia, pain in epigastrium, right and left podrebarac, positive gallbladder symptoms. When fibrogastroduodenoscopy found the following changes: surface common gastritis, multiple severe erosion in the bulb of the duodenum. Urease test with biopsies from antrum positive.

Conducted therapy aimed at the eradication Helicobacter infection.

The results of impedance metric studies of motor function of the esophagus prototype and declare the method with the patient in the hospital at the stage of diagnosis are presented in table 2.

The results of studies on the prototype indicate abnormal GER (AR>10%) with a significant height and preservation of esophageal clearance. By the present method revealed several episodes of high GER type RT2;3. Information on GER obtained by the present method and the prototype, not contradict each other.

Clinical example # 3

Patient M., aged 15, case history No. 3379

This patient was treated in the gastroenterological Department of DGIB No. 3 with 11.10.01 on 12.11.01 with a diagnosis of Gastroesophageal reflux disease. Erosive reflux esophagitis. Axial hernia hiatal. Chronic gastroduodenitis (surface common gastritis, erosive Bulba) saved acid-forming function of the stomach, associated with Helicobacter infection in the acute phase.

Was admitted with complaints of epigastric pain that occurs after eating and when the torso, and expressed diarrhoeal disorders: nausea after eating, belching air and eaten food, sour taste in the mouth, heartburn. To reduce the discomfort the patient washed down the food with water. Disease duration was 2-3 years. The history of life without the social field. X-ray examination of the esophagus was diagnosed with non-fixed axial hernia hiatal. When fibrogastroduodenoscopy found the following changes: erosive reflux esophagitis, cardia insufficiency, superficial common gastro, sharp erosion in the bulb of the duodenum. Urease test with biopsies from antrum sharply positive.

Conducted therapy aimed at the eradication Helicobacter infection: famotidine, hiconcil, de-Nol, trichopol within 7 days, then 5 day course of motilium 10 mg 3 times a day inside. After three weeks of treatment, the patient disappeared pain and dyspeptic syndromes.

The results of impedance metric studies of motor function of the esophagus of the prototype and the claimed method before and after treatment are presented in table 3.

Research motor function of the esophagus prototype revealed a positive effect of therapy on motor function of the esophagus: installed almost complete disappearance of GER. By the present method on a background of treatment, the patient was observed disappearance GER (transition RT13 in RT00). Information on GER, the work of the esophagus by the present method to get additional information. At the first examination, the patient was observed predominantly hypertensive character dyskinesia of esophagus. On the background of the treatment of the patient occurred normalization of the nature of the barrier function of the proximal esophagus - transition monotonically diffuse type (BF33) in discrete diffuse-focal (BF12); disappeared ismotorola of the esophagus with the formation of residues of refluxate in the proximal (transition RR11 in RR00). The revealed changes in motor function of the esophagus under the influence of therapy are regarded as positive, because the patient disappeared dyspeptic symptoms of GERD and pain, possibly caused by increased tone of the esophagus in response to the reflux of gastric contents. In Annex 3 and 4 shows fragments of the graph MFP, reflecting the effectiveness of therapy.

Clinical example # 4

Patient P., age 16, case history No. 3310

This patient was treated in the gastroenterological Department of DGIB No. 3 with 15.06.01 at 08.06.01 with a diagnosis of Gastroesophageal reflux disease without esophagitis. Chronic gastroduodenitis (surface spread) with saved acid-forming function of the stomach, associated with Helicobacter infection in the acute phase. Dyskinesia VC who saw complaining of aching pain in paraumbilical region, in the right and left podrebarac arising before meals and after exercise. There was also expressed diarrhoeal disorders: belching air, heartburn. Disease duration was more than three years. The disease manifestations of food Allergy. Heredity burdened by chronic cholecystitis.

On physical examination, the patient was diagnosed coated tongue, pain in the epigastric region, the right upper quadrant and along the colon. When fibrogastroduodenoscopy found the following changes: superficial antral gastritis, superficial Bullit. The SAHARA-the test is positive.

Conducted therapy: table 5, gastroporn, halsten, duphalac.

The results of impedance metric studies of motor function of the esophagus (using functional loads) on the prototype and the present method when entering a patient in the hospital at the stage of diagnosis are presented in table 4.

Research motor function of the esophagus to prototype the application of functional loads showed increased aggressiveness and height GER, faster clearance in the distal esophagus in the position of the I by the present method, found a long but low reflux (RT31). Studies GER functional loads by the present method showed a reduction in the duration of reflux of gastric contents into the esophagus with a significant increase in its height (RT31 to RT23) that does not contradict the data obtained using the prototype (AR increased four times).

In the study by the present method to get additional information. On the background of the use of functional loads, the patient had an increase in the size of the remnants of refluxate in the proximal esophagus and increase the time they are saved (transition RR11 in RR33). In annexes 5, 6 and 7 depicts a graph fragments MFP registered with the patient in sitting, lying and lying down with a load of 1 kg in the region of the epigastrium.

The revealed changes in motor function of the esophagus under the influence of functional loads indicate the inadequacy of the barrier function (BF00), which contributes to the preservation of the remnants of refluxate considerable size (RR33) in the proximal. This example demonstrates the effectiveness of using functional loads in the study of the MFP.

Clinical example # 5

Patient B., 16 years old, medical history, No. 3375

Gastroesophageal reflux disease. Superficial reflux esophagitis. Chronic gastroduodenitis (surface common gastritis, erosive Bulba) associated with Helicobacter infection in the acute phase. Biliary dyskinesia. Concomitant diagnosis: Atopic dermatitis. Nephroptosis.

Came in for planned tests with complaints of recurrent headaches, fatigue, flatulence. Suffer from chronic gastroduodenitis about three years. History of chronic tonsillitis, urinary tract infections, giardiasis. The boy smokes. Heredity burdened by chronic gastritis, diabetes mellitus.

On physical examination, the patient was identified: coated tongue posture, pain in the right hypochondrium, positive gallbladder symptoms. When fibrogastroduodenoscopy found the following changes: superficial reflux esophagitis, superficial common gastritis, multiple severe erosion in the bulb of the duodenum. Urease test with biopsies from antrum positive.

Conducted therapy aimed at the eradication Helicobacter infection: famotidine, hiconcil, de-Nol, trichopol within 7 days.

The results impedes functional loads) when enrolling a patient in the hospital at the stage of diagnosis are presented in table 5.

Research motor function of the esophagus in the normal position of the patient on the prototype has detected light (AR<10%), but high GER. The claimed method was recorded medium duration, high GER (RT23).

Research motor function of the esophagus on the background load of the prototype revealed a significant increase aggressiveness GER from 6.6 to 43.1%, normalization of esophageal clearance. By the present method have been shown to increase the duration of GER (RT23 to RT33). Therefore, the information on GER obtained by the present method and the prototype does not contradict each other.

In the study by the present method to get additional information. On the background of the application of functional loads of the patient was observed strengthening the barrier function of the proximal esophagus (passage BF11 in BF22), which contributed to the evacuation of the remnants of refluxate of the proximal esophagus (RR33 to RR00). However, the applied load caused significant reflux of gastric contents into the esophagus (RT33). In annexes 8, 9 and 10 presents a graph fragments MFP registered with the patient in sitting, lying and lying down with a load of 1 kg in apt about mainly hypotonic type of dyskinesia of esophagus. Evacuation of the remnants of refluxate when changing body position of the patient indicates the relative compensation of violations of the barrier function of the esophagus. Strengthening GER under the action of loads indicates the weakening of the locking mechanism of the cardia.

To prove the advantages of the proposed method was examined group of patients (n=37) aged 11 to 17 years of age with gastroesophageal reflux disease (GERD), confirmed by clinical data and endoscopic study.

In the survey prototype pathological GER (AR>10%) was detected in 19 patients (51,4%); the claimed method in 29 children (78,4%) was found to GER and failure of the cardia (NC) moderate and severe (RT13, RT22, RT23, RT31, RT32, RT33). Was calculated indicator of the sensitivity of the proposed method [20]. It is known that the sensitivity is defined as the proportion of individuals with a positive test result in the population with the target disease. Sensitive test rarely misses patients who have the disease. Table 6 presents data to calculate the sensitivity of the proposed method to identify GER.

The high sensitivity of the proposed method (94,7%) poscontrol medicamental correction of these violations. Unlike the prototype, the inventive method allows the graph MFP to observe the spatio-temporal picture of the GER, which gives the opportunity to evaluate the frequency, intensity, and duration of reflux.

We carried out the analysis of disorders of esophageal clearance (CL) from the second to the eighth zones examination of the esophagus detected by the prototype, and the incidence of medium and large remnants of refluxate detected by the claimed method, indirectly indicating a decrease in the rate of purification of the esophagus. Studies on the prototype and the present method is equally often in 23 patients (62.2 per cent), revealed impaired esophageal clearance (CL<10%) and hypotonic dyskinesia of esophagus moderate and severe (RR13, RR22, RR23, RR31, RR32, RR33). The results of the study are presented in table 7. Low sensitivity of the proposed method for the assessment of esophageal clearance (73,9%) explained by the different approach to calculation of values CL and RR. In the prototype indicator local clearance of the esophagus (CL) is integral, it is calculated taking into account the GER and the remnants of refluxate, as in the claimed method is an indicator of RR characterizes only the geometrical dimensions of the remnants of refluxate in the esophagus, the evaluation of GERD is p is adelene height GER prototype (HR) and the present method. It turned out that the observed patients with high GER (>11 cm) equally often revealed a prototype of the claimed method (38 and 32%, respectively). Low GER (less than 6.5 cm) was recorded only by the claimed method (11%). Hypersensitivity determine the height of GER by the claimed method is due to the different methods of its determination. In the prototype calculates the integral indicator HR, taking into account the GER and the presence of residues of refluxate, in the present method the height of the GER is determined without regard to residues of refluxate, so the information provided about the height of the GER is more accurate.

To identify additional opportunities evaluation of the MFP by the claimed method all patients were divided into three groups: patients only with endoscopic signs of GERD, and the second with clinical and endoscopic features and the third only with clinical signs. The analysis of barrier functions (BF), residues of refluxate (RR) in the proximal esophagus and type reflux (RT) are presented in table 8. Hypertension esophageal moderate and severe (BF13, BF22, BF23, BF31, BF32, BF33) was recorded in 50% of patients with clinical signs of GERD (2 and 3 groups) and only 27.3% of the patients of the 1st group that 200000/2230000/2239000/2239358-12-s.gif" border="0">

The number of patients with hypotonic dyskinesia of esophagus moderate and severe severity (RR13, RR22, RR23, RR31, RR32, RR33) was higher in the 1 and 2 groups with endoscopic signs of GERD - 36,4% and 30%, than in group 3 - 25%. The number of patients with cardia insufficiency of moderate and severe severity (RT13, RT22, RT23, RT31, RT32, RT33) was also greater in the 1 and 2 groups with endoscopic signs of GERD - 81,8% and 90%, than in group 3 - 68,8%, which correlated with the frequency of esophagitis in these groups. The detection rate expressed GER by the claimed method and the prototype in patients with GERD comparable. The prototype pathological GER (AR>10%) was diagnosed in 1 group, 45.5% of patients in group 2 - 70,0%, in group 3 - 43,8%.

Thus, we can conclude that the claimed method for the diagnosis of motor function of the esophagus is not inferior to the prototype accuracy and at the same time allows you to get more information about esophageal tone and the interaction of different parts of the esophagus, to determine the severity of his Hypo - and hypertonicity; helps to qualitatively assess the strength of the prevalence and duration of tonic contractions, which is of great importance to assess the severity of functional disorders of the esophagus and increase affectionate and hypokinesia of the esophagus. Diss. Prof. the honey. Sciences - M., 1972.

2. Ashcraft K. U., holder T. M. Gastroesophageal reflux. In the book: Pediatric surgery. SPb., Hartford, 1996.

3. Weinstein, I. a New method of x-ray diagnosis of gastro-esophageal reflux and hernia hiatal // Clinical medicine, - 1964, No. 4, - n-54-58.

4. Vasilenko C. H., grebenyov A. L. Hernia hiatal. - M.: Medicine, 1978.

5. Method for the diagnosis of gastroesophageal reflux: Patent No. 2191537 /Gonchar N. In., Petlyakov S. I., Dumova N. B, Schatz, I. A., Stojkovic S. P. - Appl. 20.12.00; Publ. 27.10.02. Bulletin no.30. - 30C.

6. Kagan E. M. X-ray diagnosis of diseases of the esophagus. - M.: Medicine, 1968.

7. The Leimen I. Bihari. Complications of gastroesophageal reflux disease // Russian journal of gastroenterology, Hepatology, Coloproctology - 1998. No. 5, - S. 69-76.

8. Mikhailov A. N. Radiology in gastroenterology. A guide for physicians. - Minsk; “Vysheishaya school, 1994.

9. Pinchuk, I. P., M. Abakumov, M., Volkov, S. V. and other Impedancometry esophagus: prospects of application and first clinical results // Ross.Journe. gastroenter., gepatol., coloproctol. - 2001. No. 1. - S. 14-20.

10. Rabkin, I. H., rocket systems C. M., Danielyan, A. x-ray film of the esophagus. - the diagnosis of gastroesophageal reflux disease // Russian gastroenterology journal. - 1999. No. 4. - S. 16-26.

20. Fletcher R., Fletcher, S., Wagner, E. Clinical epidemiology. Fundamentals of evidence based medicine. TRANS. from English. - M: Media Sphere, 1998.

12. Christie D. L., Mack, D. V., Parker A. F. et al. Use of intraoperative esophageal manometrics in surgical treatment of gastroesophageal reflux in pediatric patients// J. Pediatr. Surg. - 1978. No. 12.-P. 648-652.

13. Hill, J. L., C. A. Pelligrini et al. Technique and experience with 24-hour esophageal ph monitoring in children// J. Pediatr. Surg. - 1977. No. 12. - P. 877-887.

14. But K. Y., Yeoh, K. G., Kang, J. Y. Standard oesophageal manometry in healthy adults in Singapore// Ann. Acad. Med. Singapore. - 1999. - No. 28. - P. 189-92.

15. But K. Y., Kang, J. Y. Esophageal mucosal acid sensitivity can coexist with normal pH recording in healthy adult volunteers// J. of Gastroenterology. - 2000. - No. 35. - P. 261-264.

16. Johnson L. F., De Meester, T. R. Twenty-four hour ph monitoring in the distal esophagus// Am. J. Gastroenterol. - 1974. No. 62. - P. 325-332.

17. Jolley S. G., Johnson D. G., Herbst, J. J. et al. An assessment of gastroesophageal reflux in children extend by ph monitoring of the distal esophagus// Surgery. - 1978. - No. 84. - P. 16-22.

18. Neuhauser, E. B. D., Berenberg, W. Cardio-esophageal relaxation as a cause of vomiting in infant// Radiology. - 1947. No. 48. - R. 480-483.

19. Opie J. C., Chaye H., Fraser G. C. Fundoplication and pediatric esophageal manometry. Actual analysis over 7 years// J. Pediatr. Surg. - 1987. - No. 22. - P. 935-938.

Claims

Method for the diagnosis of motor function of the esophagus by setting the impedance of the probe above the esophago-gastric junction 2-3 cm, registration intraesophageal impedance in several areas throughout the esophagus, agar) and indices of motor function, characterized in that at lower intraesophageal impedance in any study area relative to the threshold value, taken as 100%, diagnose lowering the tone of the esophagus, when the value of the impedance of 100 - 200% of normal tone, but values above 200% - increased tone, and then build the graph esophagoenterostomy, the abscissa of which represents the time of the study, the y-axis is the distance relative to the level of the lower esophageal sphincter, put on the schedule established by the characteristics of the tone in each area of study in unit time, which unite in Hypo-, normo-and hypertensive area and designate a different color, in hypertensive parts of the graph determine the index of the barrier function of the esophagus (BF), which characterizes the severity of hypertensive disorders, on a 4-point system, with the first digit after BF is a quantitative estimate of the duration of hypertonic contractions of the esophagus and is 3 points, with the duration of hypertension, at least 90% of the time of the study, 2 points for the duration of hypertension from 40 to 90% of the time of the study, 1 point - if the duration of hypertension is not higher than 40% of the research time, 0 points - no; the second digit after BF t is prostrannie zones hypertension more than 7 cm, 2 points - for distribution of hypertension 4-7 cm, 1 point - for distribution of hypertension is not more than 4 cm, 0 points - no; and when the values BF23, BF32, BF33 diagnosed with severe hypertension dyskinesia of esophagus, when the values BF13, BF22, BF31 - medium-heavy form, when values of the BF11, BF12, BF21 - easy form; in hypotonic plots a graph on a 4-point system to determine the indicator of isolated remnants of refluxate (RR), characterizing the presence of isolated hypotonic sites in the proximal esophagus with impaired evacuation of refluxate, and indicator species reflux (RT), characterizing the degree of hypotension distal esophagus, with the first digit after RR is a quantitative estimate of the duration of delay evacuation of the remnants of refluxate and is 3 points for the duration of hypotonic plots not less than 25% of the time of the study, 2 points for the duration of the hypotonic plots from 10 to 25% research time, 1 point - at duration hypotonic stations, not more than 10% of research time, 0 points - no; the second digit after RR is a quantitative assessment of the magnitude of residues of refluxate in hypotonic parts of the esophagus and is 3 points in the plots over the aluu form hypotonic dyskinesia of esophagus, when the values RR13, RR22, RR31 - medium-heavy form, when the values RR11, RR12, RR21 - easy form; the first figure after RT is a quantitative estimate of the duration of GERD and is 3 points for the duration of hypotension at least 90% of the time of the study, 2 points - at duration 40 - 90% of the time of the study, 1 point - at duration not exceeding 40% of the research time, 0 points - no; the second digit after RT is a quantitative estimate of the height of GERD and is 3 points at the height of hypotonic plots more than 11 cm, 2 points from 6.5 to 11 cm, 1 point - less than 6.5 cm, 0 points - no, when values of RT23, RT32, RT33 diagnose cardia insufficiency is severe, when the values RT13, RT22, RT31 - cardia insufficiency moderate, with values RT11, RT12, RT21 - mild.



 

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FIELD: medicine.

SUBSTANCE: one should measure electric impedance of patient's middle ear. Electrodes should be applied in three localizations: auditory canal, anterior end of lower nasal concha and frontal skin. Electric impedance should be measured at the frequencies of sinusoidal signal being equal to 10, 30, 250 and 1000 Hz, the data obtained should be compared by values of electric impedance in the given area (middle ear) in the group of healthy patients. This method provides the chance to obtain comparative data for diagnostics of middle ear diseases.

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EFFECT: enhanced accuracy of diagnosis.

11 cl, 14 dwg, 2 tbl

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EFFECT: higher efficiency.

1 cl, 2 dwg, 2 ex, 4 tbl

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EFFECT: higher accuracy of detection.

5 dwg, 2 ex, 3 tbl

FIELD: medicine; medical engineering.

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5 cl, 5 dwg, 4 tbl

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2 cl, 4 dwg

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