The diploma thesis aims to describe the functional disorders of the upper gastrointestinal tract with an emphasis on gastroesophageal reflux disease. The theoretical part describes the anatomy, pathophysiology, etiology of GERD and treatment options. In the practical part is measured postural reactivity of the diaphragm in the selected 15 probands with GERD. We measured the postural reactivity of the diaphragm using high resolution manometry in various postural situations: lying on the back with flexion of lower limbs above the surface, standing and standing on the AIREX mat, for standing patients, we used weights of 3,6 and 9 kilos inside and outside the center of gravity. Patients also completed the GERD Health-Related Quality of Life questionnaire. The measurements confirmed an increase in resting pressure in all positions except standing, which correlated with the highest occurrence of reflux episodes in standing. The results were compared with a healthy control group. The activation of the crural part of the diaphragm was the same in both groups. We found in patients with GERD decreased coordination, delayed and influent activation of the crural diaphragm. The most significant increase in pressure in GERD patients occurred in the postural position of the flexed lower limbs and in standing...

The esophageal sphincters constitute the anatomical protection against pulmonary aspiration. The aim of this thesis was to study the esophageal sphincters and how they are affected by different components of emergency anesthesia using high-resolution solid-state manometry. The effect of propofol (0.3 mg/kg) was studied in young and elderly volunteers. Propofol can be given as an anxiolytic agent for manometric studies of the lower esophageal sphincter (LES) without affecting the results. However, propofol is not recommended for studies of the upper esophageal sphincter (UES). The effects of cricoid pressure (CP) and peripheral pain were studied in awake volunteers, with and without remifentanil infusion (5 ng/ml). Pain did not affect pressure in the LES, but CP or remifentanil induced a significant decrease in LES pressure. However, neither CP nor remifentanil affected the barrier pressure (LES-intra gastric pressure). When CP was applied during ongoing remifentanil infusion, no further decrease in LES pressure was measured. CP induced high pressures in the area of the UES independent of remifentanil infusion, indicating that CP is effective in preventing gastroesophageal regurgitation. Barrier pressure was also studied in anesthetized patients after rocuronium (0.6 mg/kg) administration and no decrease was measured. In addition, alfentanil (20 μ/kg) added during anesthesia induction with propofol did not decrease the barrier pressure. In conclusion, CP seems to be effective in preventing regurgitation and does not affect barrier pressure. Muscle relaxation with rocuronium does not risk gastro-esophageal integrity. In addition, opioids can be integrated, even during emergency anethesia, without increasing the risk for pulmonary aspiration.

Introduction The main aim of this study is to present a complex review comprising etiological factors, diagnostic options and therapeutic methods related to globus pharyngeus, a persistent or intermittent sensation of a lump or foreign body in the throat. The second purpose is to investigate the reciprocal relationship between motor control with musculoskeletal system and pressure changes in the esophagus, especially in the upper esophageal sphincter. Methods 37 patients participated in the study. 24 of them suffered globus pharyngeus and 13 were patients with GERD but without the symptoms of globus pharyngeus. Because of the complex physiology of esophageal function and the inability of conventional manometry to fully describe this complexity, we found High-Resolution Manometry as a useful device for accomlishing the referred task. Patients were examined in four different postural situations which had to be modified when the attitude wasn't tolerated. The examination was followed by manual physiotherapy and exercises targeted to influence postural alignment. 10 patients with globus pharyngeus who agreed with a control manometry examination were familiarized with the results as a form of biofeedback. Results On the basis of the results of this research, it can be concluded that a high pressure...

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The aim of this thesis is to describe information about GERD, its etiology, anatomy, pathology, treatment options and rehabilitation in patients with GERD. Lower oesophageal sphincter and antireflux barrier. The study was approved by the ethics committee. 30 probands were included in the study and their health status was verified using the Health Related Quality of Life questionnaire. A manometric catheter was inserted, proband was instructed to maintain various postural positions. Lying supine with lower limbs elevated above the surface, lying supine with lower limbs elevated above the surface with head fixated manualy, sitting and standing position, load in the center of gravity 3/6/9 kg, load outside the center of gravity 3/6/9 kg, lifting of the office chair. It has been shown that LES pressure increases in all postural positions compared to resting pressure. The positions activate the diaphragm to demonstrate the postural function of the diaphragm. The most significant change in LES pressures was in the postural position of lying supine with lower limbs elevated above the surface, the LES resting pressure of 20.34mmHg changed to the pressure of LES 40.92mmHg. Clinical experience and studies have shown that patients with GERD have disposition for respiratory and / or vertebrogenic difficulties....