1
|
Lee ME, Ghosh G, Rooney K, Soumekh A, Schnoll-Sussman F, Katz P. Prolonged acid reflux monitoring using acid exposure time and DeMeester score: two days are not enough. Surg Endosc 2024:10.1007/s00464-024-10733-x. [PMID: 38467859 DOI: 10.1007/s00464-024-10733-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/28/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Wireless pH monitoring allows for a definitive GERD diagnosis, which is essential for optimal medical or surgical management of the patient. However, there is no guideline recommendation on whether prolonged pH testing (72 or 96 h) provides additional benefit when compared to the standard 48-h testing. We aimed to assess whether prolonged pH monitoring diagnoses more patients with GERD, as well as compare the DeMeester score to acid exposure time as diagnostic criteria for GERD. METHODS This was a retrospective analysis of consecutive adult patients who underwent wireless esophageal pH monitoring between August 2018 and July 2021. The primary outcome was the additional diagnoses of GERD (predominant acid exposure pattern) in patients who underwent 48-h versus 96-h pH monitoring. Secondary outcomes included comparison of the DeMeester score to acid exposure time and internal agreement between the first and second 48-h blocks of a prolonged 96-h pH study. RESULTS When comparing 48-h versus 96-h pH testing, the prolonged monitoring group was more likely to have a predominant reflux pattern and thus be diagnosed with definitive GERD by elevated DeMeester score (58.8% vs. 40.8%, p = 0.003) or acid exposure time > 6% (44.7% vs. 32.4%, p = 0.039). For patients who underwent prolonged testing, the results of monitoring beyond 48 h led to a clinically meaningful change in study interpretation in 24.8% of patients. The study data from Days 3 to 4 yielded only a 56.6% agreement with the first 2 days. CONCLUSIONS In patients undergoing extended pH monitoring, almost half were found to have an abnormal pH study after a normal study on Day 1. An additional 25% of patients had a change in study interpretation by extending the study beyond 48 h. Our findings suggest only 48 h of pH monitoring will miss a diagnosis of GERD in a clinically important number of patients.
Collapse
Affiliation(s)
- Michelle E Lee
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA.
- Department of Medicine, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA.
| | - Gaurav Ghosh
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Katharine Rooney
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Amir Soumekh
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Felice Schnoll-Sussman
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Philip Katz
- Division of Gastroenterology and Hepatology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
2
|
Palte I, Stewart S, Rives H, Curtis JA, Enver N, Tritter A, Andreadis K, Mocchetti V, Schnoll-Sussman F, Soumekh A, Zarnegar R, Katz P, Rameau A. Virtual Reality for Pain Management During High-Resolution Manometry: A Randomized Clinical Trial. Laryngoscope 2024; 134:1118-1126. [PMID: 37497865 PMCID: PMC10818016 DOI: 10.1002/lary.30914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/20/2023] [Accepted: 07/12/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE High-resolution esophageal manometry (HRM) is the gold standard for the diagnosis of esophageal motility disorders. HRM is typically performed in the office with local anesthesia only, and many patients find it unpleasant and painful. The aim of this study was to examine the effects of the use of a virtual reality (VR) headset on pain and anxiety outcomes in patients with dysphagia undergoing HRM. METHODS Patients with dysphagia were prospectively recruited and randomized to undergo HRM with and without VR distraction. Data collected included the State-Trait Anxiety Inventory-6 (STAI-6), the Short-Form McGill Pain Questionnaire, heart rate, and galvanic skin response (GSR) tracings. RESULTS Forty subjects completed the study, including 20 subjects in the intervention arm and 20 in the control arm. There was evidence of a significant positive effect of VR on calmness (p = 0.0095) STAI-6 rating, as well as on physiologic measures of pain with significantly decreased GSR rise time (p = 0.0137) and average rate of change of conductance change (p = 0.0035). CONCLUSION The use of VR during HRM catheter insertion increased calmness compared to control. Change of skin conductance was also reduced in the VR group, suggesting decreased physiologic pain. This study supports the consideration of the use of VR as a distraction tool to improve patient comfort during HRM. LEVEL OF EVIDENCE 2 Laryngoscope, 134:1118-1126, 2024.
Collapse
Affiliation(s)
- Ilan Palte
- Sean Parker Institute for the Voice, Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Sarah Stewart
- Sean Parker Institute for the Voice, Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Hal Rives
- Sean Parker Institute for the Voice, Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medical College, New York, NY, USA
| | - James A. Curtis
- Sean Parker Institute for the Voice, Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Necati Enver
- Sean Parker Institute for the Voice, Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Andrew Tritter
- Sean Parker Institute for the Voice, Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medical College, New York, NY, USA
- Texas Voice Performance Institute, Department of Otorhinolaryngology – Head and Neck Surgery, UTHealth Houston – McGovern Medical School, Houston, TX, USA
| | - Katerina Andreadis
- Sean Parker Institute for the Voice, Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medical College, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Valentina Mocchetti
- Sean Parker Institute for the Voice, Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medical College, New York, NY, USA
| | | | - Amir Soumekh
- Division of Gastroenterology, Weill Cornell Medical College, New York, NY, USA
| | - Rasa Zarnegar
- Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Philip Katz
- Division of Gastroenterology, Weill Cornell Medical College, New York, NY, USA
| | - Anaïs Rameau
- Sean Parker Institute for the Voice, Department of Otolaryngology – Head and Neck Surgery, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
4
|
Soumekh A, Nagler J. Gastrointestinal endometriosis causing subacute intestinal obstruction with gradual development of weight loss and misdiagnosed as irritable bowel syndrome. Case Rep Gastroenterol 2014; 8:51-5. [PMID: 24574950 PMCID: PMC3934607 DOI: 10.1159/000358552] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Both endometriosis and irritable bowel syndrome (IBS) are commonly found in young women and the diagnosis of either is challenging. Alarm symptoms can exclude the diagnosis of IBS, but their onset may be insidious and often no evidence of organic disease may be found. We present a patient with a 4-year history of presumed IBS, absent gynecological symptoms, negative gastrointestinal as well as gynecological testing who developed the only alarm symptom of weight loss and was eventually found to have endometriosis of the small intestine. This case illustrates the need for constant vigilance in patients with IBS.
Collapse
Affiliation(s)
- Amir Soumekh
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, N.Y., USA
| | - Jerry Nagler
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medical College, New York, N.Y., USA
| |
Collapse
|
5
|
Holzer H, Soumekh A, Wan D. A woman with a rare cause of hemoperitoneum. Gastroenterology 2012; 143:299, 505, 506. [PMID: 22709739 DOI: 10.1053/j.gastro.2012.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 01/27/2012] [Indexed: 12/02/2022]
Affiliation(s)
- Horatio Holzer
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | | | | |
Collapse
|