Clinical Research
Copyright ©2007 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2007; 13(39): 5245-5252
Published online Oct 21, 2007. doi: 10.3748/wjg.v13.i39.5245
Transcutaneous cervical esophagus ultrasound in adults: Relation with ambulatory 24-h pH-monitoring and esophageal manometry
Sabite Kacar, Selma Uysal, Sedef Kuran, Ulku Dagli, Yasemin Ozin, Erdem Karabulut, Nurgul Sasmaz
Sabite Kacar, Sedef Kuran, Ulku Dagli, Yasemin Ozin, Nurgul Sasmaz, Gastroenterology Department, Turkiye Yuksek Ihtisas Hospital, Turkey
Selma Uysal, Radiology Department, Ankara Training and Research Hospital, Turkey
Erdem Karabulut, Biostatistics Department, Hacettepe University, Turkey
Author contributions: All authors contributed equally to the work.
Correspondence to: Sedef Kuran, MD, Gastroenterology Department, Turkiye Yuksek Ihtisas Hospital, Dikmen Cad. 220/A, No. 17 Dikmen, Ankara, Turkey.
Telephone: +90-505-2774366 Fax: +90-312-3124120
Received: May 12, 2007
Revised: June 26, 2007
Accepted: August 17, 2007
Published online: October 21, 2007

AIM: To determine the gastroesophageal refluxate in the cervical esophagus (CE) and measure transcutaneous cervical esophageal ultrasound (TCEUS) findings [anterior wall thickness (WT) of CE, esophageal luminal diameter (ELD), esophageal diameter (ED)]; to compare TCEUS findings in the patient subgroups divided according to 24-h esophageal pH monitoring and manometry; and to investigate possible cut-off values according to the TCEUS findings as a predictor of gastroesophageal reflux (GER).

METHODS: In 45/500 patients, refluxate was visualized in TCEUS. 38/45 patients underwent esophagogastroduodenoscopy (EGD), 24-h pH monitoring and manometry.

RESULTS: The 38 patients were grouped according to 24-h pH monitoring as follows: Group A: GER-positive (n = 20) [Includes Group B: isolated proximal reflux (PR) (n = 6), Group C: isolated distal reflux (DR) (n = 6), and Group D: both PR/DR (n = 8)]; Group E: no reflux (n = 13); and Group F: hypersensitive esophagus (HSE) (n = 5). Groups B + D indicated total PR patients (n = 14), Groups E + F reflux-negatives with HSE (n = 18), and Groups A + F reflux-positives with HSE (n = 25). When the 38 patients were grouped according to manometry findings, 24 had normal esophageal manometry; 7 had hypotensive and 2 had hypertensive lower esophageal sphincter (LES); and 5 had ineffective esophageal motility disorder (IEM). The ELD measurement was greater in group A + F than group E (P = 0.023, 5.0 ± 1.3 vs 3.9 ± 1.4 mm). In 27/38 patients, there was at least one pathologic acid reflux and/or pathologic manometry finding. The cut-off value for ELD of 4.83 mm had 79% sensitivity and 61% specificity in predicting the PR between Groups B + D and E (AUC = 0.775, P = 0.015).

CONCLUSION: Visualizing refluxate in TCEUS was useful as a pre-diagnostic tool for estimating GER or manometric pathology in 71.1% of adults in our study, but it was not diagnostic for CE WT.

Keywords: Ambulatory 24-h pH monitoring, Cervical esophageal ultrasound, Gastroesophageal reflux, Esophageal manometry, Esophageal refluxate