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- W2913280146 abstract "Introduction: The pathophysiology of gastroparesis is often not fully understood nor evaluated. Patients are often tried on various medications, with limiting side-effects and dietary modification with limited improvement in their symptoms. Case description: We present a 39-year-old female patient with a history of gastroesophageal reflux disease (GERD), morbid obesity and tracheal stenosis despite multiple dilations. She reported chronic regurgitation of acid and food while lying down after eating. She said she would wake up with a choking sensation, together with early morning nausea but no vomiting. She had no other systemic illness and denied any toxic habit use. She had taken various PPI's over the preceding years. Her physical exam was unremarkable except for morbid obesity with a BMI of 42. She underwent a comprehensive evaluation at our clinic. She had a high-resolution manometry study that showed weak LES resting tone with a weak esophageal body, and a subsequent impedance test showed incomplete bolus transit of the swallowed bolus with episodes of gastroesophageal and esophagopharyngeal reflux. This was followed by an upper GI series that showed significant gastroesophageal reflux extending to the upper third of the thoracic esophagus associated with a mild sliding hiatal hernia. There was marked antro-pyloric spasm with delayed gastric emptying. No gastric or duodenal stricture or ulcer was identified. Finally, she had a gastric emptying study which showed marked delayed gastric emptying and moderately decreased antral motility. The patient then underwent an EGD which showed a tight and spastic pylorus, that could be transversed with mild pressure. EndoFLIP was utilized to measure the pyloric compliance and a value of 5.0 mm2/ mmHg (normal 25.2 +/- 2.4 mm2/mmHg) was found. An area at the pylorus was successfully injected with 100 units of botulinum toxin in 5 divided quadrants. She had marked improvement in her regurgitation symptoms at follow-up visits. Discussion: Her symptoms were thus likely explained by significant gastroparesis due to pylorospasm leading to subsequent GERD and chronic laryngeal-pharyngeal reflux causing recurrent tracheal stenosis. Endoscopic functional luminal imaging probe (EndoFLIP) is a novel technique that can be used to assess pyloric physiologic characteristics. EndoFLIP can be used to diagnose and target management of patients with gastroparesis due to abnormalities in pyloric function.Figure: High resolution esophageal manometry showing belching episode with gastroesophageal reflux and esophagopharyngeal reflux." @default.
- W2913280146 created "2019-02-21" @default.
- W2913280146 creator A5033548185 @default.
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- W2913280146 date "2017-10-01" @default.
- W2913280146 modified "2023-10-17" @default.
- W2913280146 title "Gastroparesis: Check That Pylorus" @default.
- W2913280146 doi "https://doi.org/10.14309/00000434-201710001-02556" @default.
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