2011, Number 3
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Med Int Mex 2011; 27 (3)
The pH-metry and esophageal manometry as useful studies in Internal Medicine
Córdova PVH, Vega LCA, Esparza AEA, Abreu ROA
Language: Spanish
References: 130
Page: 253-269
PDF size: 619.73 Kb.
ABSTRACT
The esophageal pH-metry and manometry are two of the most requested medical examinations in the diagnosis of esophageal illness. In this field there are diseases as frequent as the Gastroesophageal Reflux Disease, and as unusual as the Achalasia. It is mandatory to know these both examinations to be able to diagnose, asses and treat adequately our patients. In the present review we state what they are, the technical issues involved, performance, and interpretation issues of these both studies. In the same way, we will review the most general statements and guidelines published in the clinical practice by the American Gastroenterological Association in relation to these diagnosis tests, useful to record the acidity level, and the pressure record in the esophagus.
REFERENCES
Spencer J. Prolonged pH recording in the study of gastrooesophageal reflux. Br J Surg 1969;56(12):912-914.
Falor WH, Hansel JR, Chang B, et al. Outpatient 24-hour esophageal monitoring by pH telemetry. Gastroenterology 1980;78:1163-1168.
Vakil N, Veldhuyzen van Zanten S, Kahrilas P, et al. The Montreal definition and classification of gastro-esophageal reflux disease (GERD) a global evidence-based consensus. Am J Gastroenterol 2006;101(8):1900-1920.
Sontag SJ. Rolling review: gastro-oesophageal reflux disease. Aliment Pharmacol Ther 1993;7(3):293-312.
Emde C, Garner A, Blum AL. Technical aspects of intraluminal pH-metry in man: current status and recommendations. Gut 1987;28(9):1177-1188.
McLauchlan G, Rawlings JM, Lucas ML, et al. Electrodes for 24 hours pH monitoring--a comparative study. Gut 1987;28(8):935-939.
Duroux P, Emde C, Bauerfeind P, et al. The ion sensitive field effect transistor (ISFET) pH electrode: a new sensor for long term ambulatory pH monitoring. Gut 1991;32(3):240-245.
Weusten BL, Akkermans LM, vanBerge-Henegouwen GP, et al. Spatiotemporal characteristics of physiological gastroesophageal reflux. Am J Physiol 1994;266(3 Pt 1):G357-362.
Branicki FJ, Evans DF, Ogilvie AL, et al. Ambulatory monitoring of oesophageal pH in reflux oesophagitis using a portable radiotelemetry system. Gut 1982;23(11):992-998.
Evans DF. Twenty-four hour ambulatory oesophageal pH monitoring: an update. Br J Surg 1987;74(3):157-161.
Klauser AG, Schindlbeck NE, Müller-Lissner SA. Esophageal 24-h pH monitoring: is prior manometry necessary for correct positioning of the electrode? Am J Gastroenterol 1990;85(11):1463-1467.
Mattox HE 3rd, Richter JE, Sinclair JW, et al. Gastroesophageal pH step-up inaccurately locates proximal border of lower esophageal sphincter. Dig Dis Dgsi 1992;37(8):1185-1191.
Singh S, Price JE, Richter JE. The LES locator: accurate placement of an electrode for 24-hour pH measurement with a combined solid state pressure transducer. Am J Gastroenterol 1992;87(8):967-970.
Schofield PM, Bennett DH, Whorwell PJ, et al. Exertional gastro-oesophageal reflux: a mechanism for symptoms in patients with angina pectoris and normal coronary angiograms. Br Med J (Clin Res Ed)1987;294(6585):1459-61.
Fass R, Hell R, Sampliner RE, et al. Effect of ambulatory 24-hour esophageal pH monitoring on reflux-provoking activities. Dig Dis Sci 1999;44(11):2263-2269.
Galmiche JP, Scarpignato C. Esophageal pH monitoring. Functional evaluation in esophageal disease. Front Gastrointest Res 1994;22:71-108.
Saraswat VA, Dhiman RK, Mishra A, et al. Correlation of 24-hr esophageal pH patterns with clinical features and endoscopy in gastroesophageal reflux disease. Dig Dis Sci 1994;39(1):199-205.
Vitale GC, Cheadle WG, Sadek S, et al. Computerized 24-hour ambulatory esophageal pH monitoring and esophagogastroduodenoscopy in the reflux patient. A comparative study. Ann Surg 1984;20(6):724-728.
Johnsson F, Joelsson B, Isberg PE. Ambulatory 24 hour intraesophageal pH-monitoring in the diagnosis of gastroesophageal reflux disease. Gut 1987;28(9):1145-1150.
Schindlbeck NE, Heinrich C, König A, et al. Optimal thresholds, sensitivity, and specificity of long-term pH-metry for the detection of gastroesophageal reflux disease. Gastroenterology 1987;93(1):85-90.
Fink SM, McCallum RW. The role of prolonged esophageal pH monitoring in the diagnosis of gastroesophageal reflux. JAMA 1984;252(9):1160-1164.
Grande L, Pujol A, Ros E, et al. Intraesophageal pH monitoring after breakfast + lunch in gastroesophageal reflux. J Clin Gastroenterol 1988;10(4):373-376.
Galmiche JP, Guillard JF, Denis P, et al. Etude du pH oesophagien en periode postprandiale chez le sufet normal et au course du syndrome de reflux gastro-oesophagien: Interet diagnostique d´un score de reflux acide. Gastroenterol Clin Biol 1980;4:531-539.
Jørgensen F, Elsborg L, Hesse B. The diagnostic value of computerized short-term oesophageal pH-monitoring in suspected gastro-oesophageal reflux. Scand J Gastroenterol 1988;23(3):363-368.
Ottington Y, Ampelas M, Voigt JJ, et al. Comparison de trios methods d´eenregistrement du pH oesophagien dans le diagnostique du reflux gastro-oesophagien acide. Gastroenterol Clin Biol 1984;8:609-615.
Klauser AG, Schindlbeck NE, Müller-Lissner SA. Symptoms in gastro-oesophageal reflux disease. Lancet 1990;335(8683):205-208.
Tefera L, Fein M, Ritter MP, et al. Can the combination of symptoms and endoscopy confirm the presence of gastroesophageal reflux disease? Am Surg 1997;63(10):933-936.
Fass R. Erosive esophagitis and nonerosive reflux disease (NERD): comparison of epidemiologic, physiologic, and therapeutic characteristics. J Clin Gastroenterol 2007;41(2):131-137.
Longo JD, Orlando RC. Nonerosive reflux disease. Minerva Gastroenterol Dietol 2007;53(2):127-141.
Fass R, Fennerty MB, Vakil N. Nonerosive reflux disease--current concepts and dilemmas. Am J Gastroenterol 2001;96(2):303-314.
DeVault KR. Review article: the role of acid suppression in patients with non-erosive reflux disease or functional heartburn. Aliment Pharmacol Ther 2006;23 suppl 1:33-9.
Numans ME, Lau J, de Wit NJ, et al. Short-term treatment with proton-pump inhibitors as a test for gastroesophageal reflux disease: a meta-analysis of diagnostic test characteristics. Ann Intern Med 2004;140(7):518-27.
Katzka DA, Paoletti V, Leite L, et al. Prolonged ambulatory pH monitoring in patients with persistent gastroesophageal reflux disease symptoms: testing while on therapy identifies the need for more aggressive anti-reflux therapy. Am J Gastroenterol 1996;91(10):2110-2113.
Dhiman RK, Saraswat VA, Mishra A, et al. Inclusion of supine period in short-duration pH monitoring is essential in diagnosis of gastroesophageal reflux disease. Dig Dis Sci 1996;41(4):764-772.
Cheadle WG, Vitale GC, Sadek SA, et al. Computerized ambulatory esophageal pH monitoring in 50 asymptomatic volunteer subjects. Results and clinical implications. Am J Surg 1988;155(3):503-508.
Kim GH, Huh KC, Lee YC, et al. Normal ambulatory 24-hour esophageal pH values in Koreans -a multicenter study. J Korean Med Sci 2008;23(6):954-958.
Pehl C, Keller J, Merio R, et al. Deutschen Gesellschaft für Neurogastroenterologie und Motilität; Arbeitsgruppe für gastrointestinale Funktionsstörungen und Funktionsdiagnostik der Osterreichischen Gesellschaft für Gastroenterologie und Hepatologie. [Esophageal 24 hour-pH metry. Recommendations of the German Society of Neurogastroenterology and Motility and the Study Group for Gastrointestinal Functional Disorders and Function Diagnostics of the Austrian Society of Gastroenterology and Hepatology] Z Gastroenterol 2003;41(6):545-556.
Spencer J. Epidemiology and natural history of gastroesophageal reflux disease. Digestion 1992;51(suppl 1):24-29.
Johnson LF, Demeester TR. Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol 1974;62(4):325-332.
Wiener GJ, Richter JE, Copper JB, et al. The symptom index: a clinically important parameter of ambulatory 24-hour esophageal pH monitoring. Am J Gastroenterol 1988;83(4):358-361.
Breumelhof R, Smout AJ. The symptom sensitivity index: a valuable additional parameter in 24-hour esophageal pH recording. Am J Gastroenterol 1991;86(2):160-164.
Weusten BLAM, Roelofs JMM, Akkermans LMA, et al. The symptom association probability: An improved method for symptom analysis of 24-hour esophageal pH data. Gastroenterology 1994;107:1741-1745.
Euler AR, Byrne WJ. Twenty-four-hour esophageal intraluminal pH probe testing: a comparative analysis. Gastroenterology 1981;80(5 pt 1):957-961.
Jamieson JR, Stein HJ, DeMeester TR, Bonavina L, et al. Ambulatory 24-h esophageal pH monitoring: normal values, optimal thresholds, specificity, sensitivity, and reproducibility. Am J Gastroenterol 1992;87(9):1102-1111.
Mattioli S, Pilotti V, Spangaro M, Grigioni WF, et al. Reliability of 24-hour home esophageal pH monitoring in diagnosis of gastroesophageal reflux. Dig Dis Sci 1989;34(1):71-78.
Masclee AA, de Best AC, de Graaf R, Cluysenaer OJ, et al. Ambulatory 24-hour pH-metry in the diagnosis of gastroesophageal reflux disease. Determination of criteria and relation to endoscopy. Scand J Gastroenterol 1990;25(3):225-230.
Schindlbeck NE, Wiebecke B, Klauser AG, Voderholzer WA, et al. Diagnostic value of histology in non-erosive gastrooesophageal reflux disease. Gut 1996;39(2):151-154.
Ghillebert G, Demeyere AM, Janssens J, Vantrappen G. How well can quantitative 24-hour intraesophageal pH monitoring distinguish various degrees of reflux disease? Dig Dis Sci 1995;40(6):1317-1324.
Kahrilas PJ, Quigley EM. Clinical esophageal pH recording:ba technical review for practice guideline development. Gastroenterology 1996;110(6):1982-1996.
Olden K, Triadafilopoulos G. Failure of initial 24-hour esophageal pH monitoring to predict refractoriness and intractability in reflux esophagitis. Am J Gastroenterol 1991;86(9):1142-1146.
Quigley EMM: 24-hour pH monitoring for gastroesophageal reflux disease: Already standard but not yet gold? Am J Gastroenterol 1992;87:1071-1075.
Jhonsson F, Joelsson B. Reproductibility of ambulatory oesophageal pH monitoring. Gut 1988;29:886-889
Wiener GJ, Morgan TM, Copper JB, Wu WC et al. Ambulatory 24-hour esophageal pH monitoring. Reproducibility and variability of pH parameters. Dig Dis Sci. 1988;33(9):1127-1133.
Pandolfino JE, Richter JE, Ours T, Guardino JM et al. Ambulatory esophageal pH monitoring using a wireless system. Am J Gastroenterol. 2003;98(4):740-749.
Pandolfino JE, Kwiatek MA. Use and utility of the Bravo pH capsule. J Clin Gastroenterol. 2008;42(5):571-578.
Pandolfino JE, Kahrilas PJ. Prolonged pH monitoring: Bravo capsule. Gastrointest Endosc Clin N Am. 2005;15(2):307-138.
Pandolfino JE. Bravo capsule pH monitoring. Am J Gastroenterol. 2005;100(1):8-10.
Lee YC, Wang HP, Chiu HM, et al. Patients with functional heartburn are more likely to report retrosternal discomfort during wireless pH monitoring. Gastrointest Endosc. 2005 Dec;62 (6):834-841.
Kahrilas PJ, Shaheen NJ, Vaezi MFAmerican Gastroenterological Association Medical Position Statement on the Management of Gastroesophageal Reflux Disease. Gastroenterology 2008;135(4):1383-1391.e5
Prakash C, Jonnalagadda S, Azar R, et al. Endoscopic removal of the wireless pH monitoring capsule in patients with severe discomfort. Gastrointest Endosc. 2006;64(5):828-32.
Food and Drug administration. MAUDE database. Available at: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/search.cfm Accessed 20/01/2009
de Hoyos A, Esparza EA, Loredo ML. Cold and Hot Snare Endoscopic Techniques for Removal of the Bravo pH Monitoring Capsule. Digestion. 2009;79(1):14-16.
Kahrilas PJ, Quigley EMM. American Gastroenterological Association medical position statement: guidelines on the use of esophageal pH recording. Gastroenterology 1996;110:1981-1996.
Talley NJ, Weaver AL, Tesmer DL, Zinsmeister AR. Lack of discriminant value of dyspepsia subgroups in patients referred for upper endoscopy. Gastroenterology 1993;105:1378–1386.
Kuipers EJ, Klinkenberg-Knol EC, Jansen EH, Tuynman HARE et al. Omeprazole as a diagnostic tool in gastro-esophageal reflux disease (abstr). Gastroenterology 1995;198:A137.
Spechler SJ, Department of Veterans Affairs Gastroesophageal Reflux Disease Study Group. Comparison of medical and surgical therapy for complicated gastroesophageal reflux disease in veterans. N Engl J Med 1992;326:786–792.
Hinder RA, Filipi CJ, Wetscher G, DeMeester TR et al. Laparoscopic Nissen fundoplication is an effective treatment for gastroesophageal reflux disease. Ann Surg 1994;220:472–481.
Bell NJV, Hunt RH. Role of gastric acid suppression in the treatment of gastroesophageal reflux disease. Gut 1992;33:118–124.
Editorial (No hay autores listados). The oesophagus and chest pain of uncertain cause. Lancet 1992;339:583–584.
Jacob P, Kahrilas PJ, Herzon G. Proximal esophageal pHmetry in patients with ’reflux laryngitis.’ Gastroenterology 1991;100: 305-310.
Irwin RS, French CL, Curley FJ, Zawacki JK et al. Chronic cough due to gastroesophageal reflux. Clinical, diagnostic, and pathogenetic aspects. Chest 1993;104:1321-1322.
Nagel RA, Brown P, Perks WH, Wilson RS, et al. Ambulatory pH monitoring of gastro-oesophageal reflux in morning dipper asthmatics. BMJ 1988;297:1371-1373.
Pelligrini CA, DeMeester TR, Wernley JA, Johnson LF, et al. Alkaline gastroesophageal reflux. Am J Surg 1978;135:177-184.
Kronecker H, Meltzer SJ. Der Schluckmechanismus, seine. Erregung und seine Hemmung. Arch Ges Anat Physiol 1883;7(Suppl):328-332.
Meltzer SJ. Recent experimental contributions to the physiology of deglutition. NY State J Med 1894;59:389-392.
Ingelfinger FJ, Abbot WO. Intubation Studies of the Human Small Intestine: Diagnostic Significance of Motor Disturbances. Am J Dig Dis Sic 1940; 7:468-474.
Winans CS, Harris LD. Quantitation of lower esophageal sphincter competence. Gastroenterology 1967;52(5):773-778.
Cohen S, Harris LD. Lower esophageal sphincter pressure as an index of lower esophageal sphincter strength. Gastroenterology 1970;58(2):157-162.
Ali MA, Lacy BE. Esophageal manometry and pH monitoring: gastroenterologists’ adherence to published guidelines. J Clin Gastroenterol 2005;39(7):584-590.
Ergun GA, Kahrilas PJ. Clinical applications of esophageal manometry and pH monitoring. Am J Gastroenterol 1996;91(6):1077-1089.
Nayar DS, Khandwala F, Achkar E, Shay SS, et al. Esophageal manometry: assessment of interpreter consistency. Clin Gastroenterol Hepatol 2005;3(3):218-224.
Katz PO, Menin RA, Gideon RM. Utility and standards in esophageal manometry. J Clin Gastroenterol 2008;42(5):620-626.
Lacy BE, Paquette L, Robertson DJ, et al. The Clinical Utility of Esophageal Manometry. J Clin Gastroenterol 2009.
Mehendiratta V, Dimarino AJ, Cohen S. Clinical Utility of Selective Esophageal Manometry in a Tertiary Care Setting. Dig Dis Sci 2008.
Ragunath K, Williams JG. A review of oesophageal manometry testing in a district general hospital. Postgrad Med J 2002;78(915):34-36.
Hart PA, Arora A, Francis DL. Utility of software analysis of esophageal manometry studies in patients with aperistalsis. Dis Esophagus 2009;22(1):80-83.
Stef JJ, Dodds WJ, Hogan WJ, Linehan JH, et al. Intraluminal esophageal manometry: an analysis of variables affecting recording fidelity of peristaltic pressures. Gastroenterology 1974;67(2):221-230.
Arndorfer RC, Stef JJ, Dodds WJ, Linehan JH, et al. Improved infusion system for intraluminal esophageal manometry. Gastroenterology 1977;73(1):23-27.
Takeuchi S, Tohara H, Kudo H, Otsuka K et al. An optic pharyngeal manometric sensor for deglutition analysis. Biomed Microdevices 2007;9(6):893-899.
Castell JA, Dalton CB, Castell DO. Pharyngeal and upper esophageal sphincter manometry in humans. Am J Physiol 1990;258(2 Pt 1):G173-178.
Pursnani KG, Oeffner C, Gideon RM, Castell DO. Comparison of lower oesophageal sphincter pressure measurement using circumferential vs unidirectional transducers. Neurogastroenterol Motil 1997;9(3):177-180.
Richter JE, Wu WC, Johns DN, Blackwell JN, et al. Esophageal manometry in 95 healthy adult volunteers. Variability of pressures with age and frequency of “abnormal” contractions. Dig Dis Sci 1987;32(6):583-592.
Tutuian R, Elton JP, Castell DO, Gideon RM, et al. Effects of position on oesophageal function: studies using combined manometry and multichannel intraluminal impedance. Neurogastroenterol Motil 2003;15(1):63-67.
Gideon RM. Manometry: technical issues. Gastrointest Endosc Clin N Am 2005;15(2):243-255.
Tutuian R, Castell DO. Esophageal function testing: role of combined multichannel intraluminal impedance and manometry. Gastrointest Endosc Clin N Am 2005;15(2):265-275.
Murray JA, Clouse RE, Conklin JL. Components of the standard oesophageal manometry. Neurogastroenterol Motil 2003;15(6):591-606.
Cho YK, Choi MG, Park JM, Oh JH, et al. Evaluation of esophageal function in patients with esophageal motor abnormalities using multichannel intraluminal impedance esophageal manometry. World J Gastroentero 2006;12(39):6349-6354.
Meyer GW, Austin RM, Brady CE, Castell DO. Muscle anatomy of the human esophagus. J Clin Gastroenterol 1986;8(2):131-134.
Liu J, Parashar VK, Mittal RK. Asymmetry of lower esophageal sphincter pressure: is it related to the muscle thickness or its shape? Am J Physiol 1997;272(6 Pt 1):G1509-1517.
McLean TR, Bombeck CT, Nyhus LM. Preservation of lower esophageal sphincter asymmetry after acid-induced abolition of the high-pressure zone. Am Surg 1986;52(8):418-422.
Kahrilas PJ, Lin S, Chen J, Manka M. The effect of hiatus hernia on gastro-oesophageal junction pressure Gut 1999;44(4):476-482.
Goyal RK, Sangree MH, Hersh T, Spiro HM. Pressure inversion point at the upper high pressure zone and its genesis. Gastroenterology 1970;59(5):754-759.
Holloway RH, Blank EL, Takahashi I, Dodds WJ, et al. Electrical control activity of the lower esophageal sphincter in unanesthetized opossums. Am J Physiol 1987;252(4 Pt 1):G511-21.
Kahrilas PJ, Dodds WJ, Hogan WJ. Effect of peristaltic dysfunction on esophageal volume clearance. Gastroenterology 1988;94(1):73-80.
Kahrilas PJ, Dodds WJ, Dent J, Logemann JA, et al. Upper esophageal sphincter function during deglutition. Gastroenterology 1988;95(1):52-62.
Dire C, Shi G, Manka M, Kahrilas PJ. Manometric characteristics of the upper esophageal sphincter recorded with a microsleeve. Am J Gastroenterol 2001;96(5):1383-1389.
John E. Pandolfino, Peter J. Kahrilas AGA technical review on the clinical use of esophageal manometry. Gastroenterology 2005;128:209-224.
Kahrilas PJ, Clouse RE, Hogan WJ. American Gastroenterological Association technical review on the clinical use of esophageal manometry. Gastroenterology 1994;107:1865-1884.
Richter JE Oesophageal motility disorders. Lancet 2001;358:823-828.
Birgisson S, Richter JE. Achalasia: what’s new in diagnosis and treatment? Dig Dis 1997;15 Suppl 1:1-27.
Goldblum JR, Whyte RI, Orringer MB, Appelman HD. Achalasia. A morphologic study of 42 resected specimens. Am J Surg Pathol 1994;18(4):327-337.
Vaezi MF, Richter JE. Diagnosis and management of achalasia. American College of Gastroenterology Practice Parameter Committee. Am J Gastroenterol 1999;94(12):3406-3412.
Holloway RH, Dodds WJ, Helm JF, Hogan WJ et al. Integrity of cholinergic innervation to the lower esophageal sphincter in achalasia. Gastroenterology 1986;90(4):924-929.
Sperandio M, Tutuian R, Gideon RM, Katz PO et al. Diffuse esophageal spasm: not diffuse but distal esophageal spasm (DES). Dig Dis Sci 2003;48(7):1380-1384.
Katz PO, Dalton CB, Richter JE, Wu WC et al. Esophageal testing of patients with noncardiac chest pain or dysphagia. Results of three years’ experience with 1161 patients. Ann Intern Med 1987 Apr;106(4):593-597.
Dalton CB, Castell DO, Hewson EG, Wu WC et al. Diffuse esophageal spasm. A rare motility disorder not characterized by high-amplitude contractions. Dig Dis Sci 1991;36(8):1025-8.
Spechler SJ, Castell DO. Classification of oesophageal motility abnormalities. Gut 2001;49(1):145-51.
Katzka DA, Sidhu M, Castell DO. Hypertensive lower esophageal sphincter pressures and gastroesophageal reflux: an apparent paradox that is not unusual. Am J Gastroentero 1995;90(2):280-4.
Coenraad M, Masclee AA, Straathof JW, Ganesh S et al. Is Barrett’s esophagus characterized by more pronounced acid reflux than severe esophagitis? Am J Gastroenterol. 1998;93(7):1068-72.
Loughney T, Maydonovitch CL, Wong RK. Esophageal manometry and ambulatory 24-hour pH monitoring in patients with short and long segment Barrett’s esophagus. Am J Gastroenterol 1998;93(6):916-919.
Patti MG, Perretta S, Fisichella PM, D’Avanzo A et al. Laparoscopic antireflux surgery: preoperative lower esophageal sphincter pressure does not affect outcome. Surg Endosc 2003;17(3):386-389.
Mughal MM, Bancewicz J, Marples M. Oesophageal manometry and pH recording does not predict the bad results of Nissen fundoplication. Br J Surg 1990;77(1):43-45.
Garcia-Pulido J, Patel PH, Hunter WC, Douglas JE, et al. Esophageal contribution to chest pain in patients with coronary artery disease. Chest 1990;98(4):806-810.
Hewson EG, Sinclair JW, Dalton CB, Richter JE. Twentyfour- hour esophageal pH monitoring: the most useful test for evaluating noncardiac chest pain. Am J Med 1991;90(5):576-583.
DeMeester TR, O’Sullivan GC, Bermudez G, Midell AI, et al. Esophageal function in patients with angina-type chest pain and normal coronary angiograms. Ann Surg 1982;196(4):488-498.
de Caestecker JS, Blackwell JN, Brown J, Heading RC. The oesophagus as a cause of recurrent chest pain: which patients should be investigated and which tests should be used? Lancet 1985;2(8465):1143-1146.
Cohen S, Fisher R, Lipshutz W, Turner R, et al. The pathogenesis of esophageal dysfunction in scleroderma and Raynaud’s disease. J Clin Invest 1972;51(10):2663-2668.
LeRoy EC, Black C, Fleischmajer R, Jablonska S, et al. Scleroderma (systemic sclerosis): classification, subsets and pathogenesis. J Rheumatol 1988;15(2):202-205.
Costigan DJ, Clouse RE. Achalasia-like esophagus from amyloidosis. Dig Dis Sci 1983;28:763-766.
Chritensen J. Esophageal manometry in mixedema. Gastroenterology 1967;52:1130-1132.