Multichannel intraluminal impedance (MII) is a new technique for evaluation of bolus transport. We evaluated esophageal function using bolus transport time (BTT) and contraction wave velocity (CWV) of liquid, semisolid, and solid boluses. Ten healthy subjects underwent MII swallow evaluation with various boluses of sterile water (pH 5), applesauce, three different sized marshmallows, and iced and 130 degrees F water. The effect of bethanechol was also studied. There was no difference in BTT or CWV for all water volumes from 1 to 20 ml. There was significant linear increase of BTT with progressively larger volumes of applesauce, and BTT of applesauce was longer than for water. BTT was significantly longer with large marshmallows vs. small and medium and was longer than for water. BTT for iced water was similar to 130 degrees F water. Applesauce showed a significant linear decrease of CWV with progressively larger volumes and was slower than water. Marshmallow showed significantly slower CWV with the large vs. small, and CWV for ice water was significantly slower than 130 degrees F water. Therefore, BTT of liquid is constant, whereas BTT of semisolid and solid are volume dependent and longer than liquids. CWV of semisolids and solids are slower than liquids. CWV of cold liquids is slower than warm liquids. MII can be used as a discriminating test of esophageal function.
"Although bolus transport time and contraction wave velocity are similar with different water volumes, these outcomes are positively and inversely correlated, respectively, with increasing apple sauce bolus volume . To help accommodate these differences, which are likely to be associated with disparate viscosities, we chose a bolus volume for apple sauce (3-ml) which was smaller than the traditional water bolus volume (5-ml). "
[Show abstract][Hide abstract] ABSTRACT: Esophageal manometry utilizes water swallows to evaluate esophageal motor abnormalities in patients with dysphagia, chest pain, or reflux symptoms. Although manometry is the gold standard for evaluation of these symptoms, patients with dysphagia often have normal results in manometry studies.
The objective of this work was to test the hypothesis that challenging the esophagus with viscous apple sauce boluses uncovers motor abnormalities in patients with dysphagia not seen when using water swallows.
High-resolution esophageal manometry was performed using ten water swallows followed by ten apple sauce swallows in consecutive subjects presenting with dysphagia. Subjects with grossly abnormal water swallow evaluations were excluded. Each swallow was categorized as normal, hypotensive (distal isobaric contour plots of < 30 mmHg over >5 cm), or simultaneous (distal esophageal velocity ≥ 8.0 cm/s). Ineffective esophageal motility (IEM) was defined as ≥ 30% hypotensive swallows, and pressurization was defined as ≥ 20% simultaneous pressure waves.
Data from 41 subjects was evaluated. Overall, 96.3% of water swallows were normal, 2.9% hypotensive, and 0.7% simultaneous. Only 70.3% of viscous swallows were normal; 16.7% were hypotensive and 13.0% were simultaneous (P < 0.001 all groups). Seven (17.1%) met criteria for IEM, and pressurization with viscous swallows was observed for nine (22.0%). Fourteen subjects (34.1%) had abnormal results from viscous studies. The presence of any abnormal water swallows was predictive of abnormal viscous swallows (OR = 9.00, CI = 2.15-80.0), although the presence of hypotensive or simultaneous water swallows was not associated with IEM (OR = 0.63, CI = 0.16-2.17) or pressurization (OR = 7.00, CI = 0.90-315.4) with viscous apple sauce.
Apple sauce challenge increased identification of classifiable motor disorders in patients with dysphagia and may be preferred to alternative bolus materials.
"A pair of electrodes is typically referred to as a channel. The impedance changes are used to study the gastroesophageal reflux patterns and the esophagus clearance (Shay et al 2002, Srinivasan et al 2001). The measured impedance depends on many factors including electrode configuration (i.e. "
[Show abstract][Hide abstract] ABSTRACT: The measurement of the electrical impedance inside the esophagus provides information about its status, and is being explored in the study of the gastroesophageal reflux. This paper presents theoretical computation of impedance inside the esophagus. The results of the numerical solution for a simple geometry are compared against the solution formulated from the Green's function approach. The effect of the electrode configuration on the resulting impedance is studied as an application of the methodology developed in this paper. The results of this paper will be useful in the design of an intraluminal impedance catheter as well as in the interpretation of the resulting impedance signals.
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