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Purpose: The aim was to study High Resolution Anorectal Manometry (HRAM) in Egyptian population and the influence of age, gender and parity on manometric parameters. Methods: We studied 22 healthy volunteers 10 males and 12 females with median age 42 y (range: 18-61 y) by using solid state probe with 8 transducers 1 cm spaced with a rectal balloon mounted at the tip. The system is plotting graphs with high resolution topography and conventional pressure waves trac- ing as well (Solar GI MMS). Probe was introduced through the anal verge so the balloon is located at the rectum and the sensors at the rectum and analcanal. External EMG electrodes were applied on either sides of anus. Subjects were asked to relax, squeeze the anal sphincter, bear down, and cough to meas- ure anal pressures at these situations. Rectal sensation and recto-anal inhibi- tory reflex (RAIR) were evaluated by stepwise intermittent (10 ml) balloon distention. Finally balloon expulsion test was done. Results: Anal resting and maximum squeeze pressure were significantly higher in males than females (median; range: 61; 45-71 and 140.0; 67-224 vs. 42; 32-67 and 117; 58-220 respectively, P0.05), while squeeze time, pressure increase to cough, push relaxation, RAIR, rectal sensation, and EMG were comparable in males and females. Age negatively correlated with some anorectal parameters (table 1), simi- larly parity negatively correlated with anal resting (r=-0.52, p 0.05) and squeeze pressure (r=-0.56, p0.05). All subjects were able to expel the balloon. Conclusion: HRAM helps understanding anorectal physiology. It is influenced by age, gender, and parity. This study can aid in diagnosis anorectal dysfunc- tion in Egyptian population.

Purpose: The aim was to study High Resolution Anorectal Manometry (HRAM) in Egyptian population and the influence of age, gender and parity on manometric parameters. Methods: We studied 22 healthy volunteers 10 males and 12 females with median age 42 y (range: 18-61 y) by using solid state probe with 8 transducers 1 cm spaced with a rectal balloon mounted at the tip. The system is plotting graphs with high resolution topography and conventional pressure waves trac- ing as well (Solar GI MMS). Probe was introduced through the anal verge so the balloon is located at the rectum and the sensors at the rectum and analcanal. External EMG electrodes were applied on either sides of anus. Subjects were asked to relax, squeeze the anal sphincter, bear down, and cough to meas- ure anal pressures at these situations. Rectal sensation and recto-anal inhibi- tory reflex (RAIR) were evaluated by stepwise intermittent (10 ml) balloon distention. Finally balloon expulsion test was done. Results: Anal resting and maximum squeeze pressure were significantly higher in males than females (median; range: 61; 45-71 and 140.0; 67-224 vs. 42; 32-67 and 117; 58-220 respectively, P0.05), while squeeze time, pressure increase to cough, push relaxation, RAIR, rectal sensation, and EMG were comparable in males and females. Age negatively correlated with some anorectal parameters (table 1), simi- larly parity negatively correlated with anal resting (r=-0.52, p 0.05) and squeeze pressure (r=-0.56, p0.05). All subjects were able to expel the balloon. Conclusion: HRAM helps understanding anorectal physiology. It is influenced by age, gender, and parity. This study can aid in diagnosis anorectal dysfunc- tion in Egyptian population.

Purpose: The aim was to study the manometric patterns of systemic sclerosis (SS) by esophageal High Resolution Manometry (HRM). Methods: Fifteen patients with SS were studied with a solid state 32-channel esophageal HRM assembly (Solar GI MMS). Ten 5-ml water swallows were given with 30 sec apart. Studies were analyzed for resting LES tone, LES resid- ual pressure, peristalsis integrity, UES resting tone and UES residual pressure. The results compared with HRM data of 15 healthy volunteers. Results: Fifteen female patients, median age 48 y range (36-62) and disease duration 4.5 y (1-12). Controls were 7 males and 8 females median age 40 y (29-56). 33% had SS of cutaneous diffuse type, and 66% limited type. The main symptoms were dysphagia in 40%, heartburn 27%, and dyspepsia 13%. While 20% had no foregut symptoms. Manometric abnormalities were found in 66% of patients. 5 patterns of esophageal dysmotility were observed: Low LES tone with aperistalsis in 27%, low LES tone and UES tone with aperistalsis 13% (Fig- ure 1), aperistalsis 13%, (Figure 2) hypoperistalsis of proximal esophagus 7%, and low UES tone in 7%. Normal esophageal motility was reported in 33% [68] Table 1. Median (range) of manometric measurements of SS[68] Table 1. Median (range) of manometric measurements of SS LES tone mmHg LES residual mmHg LES length cm UES tone mmHg UES residual mmHg UES length cm Systemic sclerosis 15.5 (3-29) 4 (2–23) 2.3 (2–3.6) 47.5 (11–223) 4 (0–39) 2.3 (2–2.5) Control 24 (9–41) 4(−2 to 22) 2.8 (2.1–3.8) 67 (20–200) 5 (−2 to 16) 2.2 (1.9–2.7) P value 0.02 0.683 0.123 0.505 0.880 0.86 Median LES tone was significantly lower than that in controls (Table 1)while LES residual pressure, UES tone and residual pressure were comparable, simi- larly were LES and UES lengths. Conclusion: Esophageal manometric abnormalities are common in SS. Vari- ous segments of the esophagus are involved. The most common pattern is low LES tone and aperistalsis of the body.

Purpose: The aim was to study the manometric patterns of systemic sclerosis (SS) by esophageal High Resolution Manometry (HRM). Methods: Fifteen patients with SS were studied with a solid state 32-channel esophageal HRM assembly (Solar GI MMS). Ten 5-ml water swallows were given with 30 sec apart. Studies were analyzed for resting LES tone, LES resid- ual pressure, peristalsis integrity, UES resting tone and UES residual pressure. The results compared with HRM data of 15 healthy volunteers. Results: Fifteen female patients, median age 48 y range (36-62) and disease duration 4.5 y (1-12). Controls were 7 males and 8 females median age 40 y (29-56). 33% had SS of cutaneous diffuse type, and 66% limited type. The main symptoms were dysphagia in 40%, heartburn 27%, and dyspepsia 13%. While 20% had no foregut symptoms. Manometric abnormalities were found in 66% of patients. 5 patterns of esophageal dysmotility were observed: Low LES tone with aperistalsis in 27%, low LES tone and UES tone with aperistalsis 13% (Fig- ure 1), aperistalsis 13%, (Figure 2) hypoperistalsis of proximal esophagus 7%, and low UES tone in 7%. Normal esophageal motility was reported in 33% [68] Table 1. Median (range) of manometric measurements of SS[68] Table 1. Median (range) of manometric measurements of SS LES tone mmHg LES residual mmHg LES length cm UES tone mmHg UES residual mmHg UES length cm Systemic sclerosis 15.5 (3-29) 4 (2–23) 2.3 (2–3.6) 47.5 (11–223) 4 (0–39) 2.3 (2–2.5) Control 24 (9–41) 4(−2 to 22) 2.8 (2.1–3.8) 67 (20–200) 5 (−2 to 16) 2.2 (1.9–2.7) P value 0.02 0.683 0.123 0.505 0.880 0.86 Median LES tone was significantly lower than that in controls (Table 1)while LES residual pressure, UES tone and residual pressure were comparable, simi- larly were LES and UES lengths. Conclusion: Esophageal manometric abnormalities are common in SS. Vari- ous segments of the esophagus are involved. The most common pattern is low LES tone and aperistalsis of the body.

PURPOSE: To compare the performance of QFG-IT and TST tests in identifying active tuberculosis (TB) and latent tuberculosis infection (LTBI) in high TB burden settings in a LMIC. METHODS: We compared the 2 tests in a cohort of 210 participants classified into three groups; Group I investigated for LTBI and included 74 health care workers (HCWs), Group II; 83 patients investigated for active TB disease, Group III; 53 healthy control subjects. RESULTS: QFG-IT was positive in 31.1%, 48.2% 11.3% of the three groups, respectively. 10.0% from the enrolled cohort had indeterminate QFG-IT results. In patients investigated for active TB, QFG-IT was positive in 84.2% of pulmonary, and in 56.4% of extra-pulmonary TB proved cases. Sensitivity, specificity, positive and negative predictive values of QFG-IT were 65.62%, 80%, 95%, and 28.6%, meanwhile they were 90.57%, 50%, 90.57% and 33.33% for TST, respectively. Positive QFG-IT tests were associated with older age, female gender, BCG vaccination and longer duration of work in health care setting. Overall agreement between the 2 tests was moderate (75.66%, κ 0.526). CONCLUSIONS: We showed moderate agreement between TST and QFG-IT test in diagnosing LTBI and active TB infection in high burden setting. Despite higher specificity of QFG-IT test, TST remains a cost effective test in LMICs with limited budget for use of IGRA tests in national control programs. CLINICAL IMPLICATIONS: QFG-IT in conjunction with TST improves the diagnostic yield, justifying its use in difficult to diagnose situations in active TB. Also, it can help identifying at- risk groups and reduce the indication of preventive chemotherapy in high burden settings.

We examined the value of impedance monitoring in measuring bolus volume compared with videoesophagram. Eighty consecutive subjects were studied with simultaneous impedance-manometry-videoesophagram. A catheter with both an impedance electrode pair and a pressure transducer at four sites (5, 10, 15, 20 cm above lower esophageal sphincter) was passed per nares. Six 10-cc boluses of 45% barium mixed with 0.9% NaCl were swallowed at 20- to 30-second intervals. When impedance fell to below 1000 ohms, other than that occurring during administered swallows, the videofluoroscopic image corresponding to the time of impedance nadir was reviewed. If barium was present at the impedance site, barium area was calculated. The video was reviewed for the cause of abnormal barium transit causing barium presence. We found 38/80 subjects had a total of 169 impedance falls to below 1000 ohms. Ninety-seven percent (164/169) of impedance falls had barium present at the impedance site, and there was good correlation (r = 0.83, P 0.001) between impedance nadir value and barium area. The impedance nadir value : barium area relationship was similar for the three causes of barium presence identified by video: failed bolus clearing; gastroesophageal reflux; and esophageal escape. Impedance nadir values 700-999 ohms usually had a small barium area. In contrast, nadir values 400 ohms had a large barium area covering all or most of the catheter and filling the esophagus at the impedance site. Impedance falls from >1000 ohms to a low nadir value from all forms of abnormal esophageal bolus transit imply a large bolus amount.

Study of intestinal flow by combined videofluoros- copy, manometry, and multiple intraluminal impedance. Am J Physiol Gastrointest Liver Physiol 286: G263–G270, 2004. First published September 25, 2003; 10.1152/ajpgi.00228.2003.—Assessment of pat- terns of flow in the small bowel is difficult. Multiple intraluminal impedance has been recently used for study of flow dynamics in the esophagus. Our aims were 1) to validate multiple intraluminal imped- ance by correlating impedance events with intestinal flow as detected by fluoroscopy and 2) to determine intestinal flow patterns in the fasting and postprandial period and their correspondence with ma- nometry. First, six healthy subjects underwent simultaneous video- fluoroscopic, manometric, and impedance recording from the duode- num. Videofluoroscopy was used to validate impedance patterns corresponding with barium flow in the fasting and postprandial periods. Next, 16 healthy subjects underwent prolonged simultaneous recording of impedance and manometry in both periods. Most flow events were short (10 cm or less), with antegrade flow being the most common. Correspondence between impedance and videofluoroscopy increased with increasing length of barium flow. Impedance corre- sponded better with flow, at any distance, than manometry. However, impedance and manometric events, when analyzed separately as index events, always corresponded with fluoroscopic flow. The fasting and postprandial periods showed comparable patterns of flow, with fre- quent, highly propulsive manometric and impedance sequences. Mo- tility index was positively and significantly associated with length of impedance events. Phase 3 of the migrating motor complex could be easily recognized by impedance. Multiple intraluminal impedance can detect intestinal flow events and corresponds better with fluoroscopic flow than manometry.

Bolus transit patterns in healthy subjects: a study using simultaneous im- pedance monitoring, videoesophagram, and esophageal manometry. Am J Physiol Gastrointest Liver Physiol 288: G1000–G1006, 2005; doi:10.1152/ajpgi.00372.2004.—Impedance monitoring (Imp) mea- sures bolus transit. Combining Imp with manometry (EM) allows the effect of contractile patterns on transit to be assessed. The objective of this study is to identify bolus transit patterns in normal subjects, correlate Imp findings with the gold standard barium esophagram (Ba), and compare bolus transit with concomitant EM findings. Simultaneous Ba-Imp-EM was performed for 2 min in 15 normal volunteers (women, 11; age, 43 yr). Combined impedance-pressure sites were 5, 10, 15, 20 cm above the lower esophageal sphincter (LES). Boluses (10 ml) of 45% barium mixed with 0.9% NaCl were swallowed at