A 24 órás pH-monitorozás és a nyelőcső-manometria szerepe felső gastrointestinalis panaszokkal jelentkező betegek kivizsgálásában = The value of twenty-four hour intraoesophageal pH monitoring and manometry in the management of patients with upper gastrointestinal symptoms

A funkcionalis gasztroenterologiai vizsgalatok (intraoesophagealis pH-meres, nyelőcső-manometria, szcintigrafia, impedanciavizsgalat) egyre inkabb nelkulozhetetlenek az endoszkoposan negativ felső gastrointestinalis panaszokkal rendelkező betegek diagnosztikajaban es adekvat kezeleseben. Betegek es modszer: Munkankban negy olyan tipusos esetet ismertetunk, amikor e vizsgalatok segitsegevel sikerult a korrekt diagnozist felallitani, es ennek alapjan a megfelelő terapias strategiat kialakitani. Kozuluk ket fiatal beteg gastrooesophagealis reflux tunetegyuttes miatt, ket beteg pedig nyelesi panaszok miatt kerult vizsgalatokra. Az intraoesophagealis pH-merest Zinetics tobbszor hasznalatos, 24 oras intraoesophagealis egy-, illetve ketcsatornas kateterrel, a nyelőcső-manometriat Zinetics negycsatornas EMC-kateterrel, folyadekperfuzios modszerrel vegeztuk. Esetismertetesek: Refluxtunetekkel rendelkező betegeink kozul egyikuknel also oesophagussphincter-inkompetencia talajan kialakult 24 oras pH-meressel igazolt koros gastrooesophagealis savas refluxot eszleltunk hiatus hernia es megtartott nyelőcső-perisztaltika mellett az oesophagealis es extraoesophagealis tunetek hattereben. Mivel teljes panaszmentessege protonpumpagatlo kezelessel sem volt biztosithato, antirefluxműtetet indikaltunk. Masik betegunknel normalis oesophagus-pH-meresi es a manometrias eredmeny alapjan hiperszenzitiv oesophagust velemenyeztunk, a protonpumpagatlo adagjat duplajara emeltuk. Jelenleg mindket betegunk panaszmentes. Masik ket betegunk nyelesi keptelensegről, jelentős fogyasrol panaszkodott. A nyelőcső-manometria alapjan mindkettőjuknel nem relaxalo also oesophagealis sphinctert, hipomotilis nyelőcsovet, achalasianak megfelelő kepet eszleltunk. Endoszkopos nyelőcső-ballondilataciot kovetően a betegek nyelese rendeződott, taplalkozasra kepesse valtak. Kovetkeztetesek: Eseteink jol peldazzak a 24 oras pH-meres es a manometria szerepenek jelentőseget a gastrooesophagealis refluxbetegseg es a nyelesi nehezitettseg, az extraoesophagealis manifesztaciok, a nem cardialis eredetű mellkasi fajdalom diagnosztikajaban. E vizsgalatok fontos szerepet jatszanak a helyes terapias strategia kialakitasaban, a műteti vagy endoszkopos operativ kezeles indikalasaban es e beavatkozasok utan a betegek koveteseben. | Functional gastroenterological examinations (intraoesophageal pH monitoring, oesophageal manometry, scintigraphy, impedance examination) play important role in the management of patients with upper gastrointestinal complaints. Patients and methods: Four different cases are demonstrated where diagnose and therapy was developed by these examinations. Two patients had typical gastro-oesophageal reflux symptoms and two others had dysphagia. Intraoesophageal pH monitoring was performed by Zinetics twenty-four hour one or two channel pH catheters and oesophageal manometry was carried out by Zinetics EMC four channel catheter with water perfusion method. Case reports: In one of the patients with typical and extraoesophageal reflux symptoms, lower oesophageal sphincter incompetency by manometry and pathological acid reflux was observed by intraoesophageal pH monitoring, respectively. Furthermore, hiatal hernia was established, peristalsis of the oesophagus proved to be preserved. Because of incomplete efficacy of proton pump inhibitor (PPI) therapy, antireflux surgery was indicated. An other patient with reflux symptoms had physiological pH monitoring and manometric values. Hypersensitive oesophagus was diagnosed and PPI therapy in double dose was applied. Both patients are symptom free up to now. Other two patients complained difficult swallowing and weight loss. Absence of lower oesophageal sphincter relaxation and hypomotility of the oesophagus was observed. After oesophageal dilatation, both patients with achalasia could easy swallow and eat. Conclusions: Our cases confirm the importance of the twenty-four hour intraoesophageal pH monitoring and oesophageal manometry in the diagnosis of gastro-oesophageal reflux disease, non-cardiac chest pain, other extraoesophageal manifestations and dysphagia. These examinations support the decision for the adequate therapeutic strategy (conventional treatment, surgery or operation or endoscopic intervention) and are important in the follow-up of patients.