Proximal and distal esophageal contractions have similar manometric features.
ABSTRACT The human esophagus is composed of striated muscle proximally and of smooth muscle distally with a transition zone between the two. Striated muscle contracts much faster than smooth muscle. The change in pressure over time (dP/dt) of the contraction amplitude should therefore be higher in proximal than in distal esophagus, reflecting the presence of striated muscle proximally. There were 34 normal esophageal manometries of patients analyzed for swallow amplitude and dP/dt in the pharynx and esophagus. An additional 11 healthy controls were similarly studied. Amplitudes in pharynx and proximal and distal esophagus were not different. The mid-esophagus had a pressure trough (P < 0.001). The dP/dt in the pharynx was much higher than that in the esophagus (P < 0.001). The dP/dt of proximal and distal esophagus were of the same order of magnitude. The manometric behavior of the striated muscle portion of the proximal esophagus differs from that seen in the pharynx and shows similar characteristics to distal esophageal smooth muscle.
Article: Clarification of the esophageal function defect in patients with manometric ineffective esophageal motility: studies using combined impedance-manometry.[show abstract] [hide abstract]
ABSTRACT: Combined multichannel intraluminal impedance (MII) and manometry (MII-EM) recently became available as an esophageal function test. Initial studies in healthy volunteers have shown that a proportion of ineffective contractions actually have complete bolus transit. The aim of our study is to evaluate esophageal bolus transit in patients with manometric patterns of ineffective esophageal motility (IEM). All patients referred for esophageal function testing during a 9-month period underwent combined MII-EM studies, including 10 liquid and 10 viscous swallows. IEM is defined as >or=30% liquid swallows with contraction amplitude <30 mm Hg in the distal esophagus. Diagnosis of esophageal transit abnormalities is defined as abnormal bolus transit if >or=30% of liquid and >or=40% of viscous swallows had incomplete bolus transit. Seventy patients (35 women; mean age, 54 yr; range, 17-86 yr) with a manometric diagnosis of IEM were identified of a total of 350 combined MII-EM studies. In these patients, 68% of liquid and 59% of viscous swallows showed normal bolus transit, and almost one third of patients received an overall diagnosis of normal bolus transit for both liquid and viscous swallows. Our experience with combined MII-EM in patients with a manometric diagnosis of IEM confirms the suspicion that "effectiveness" should only be determined by using a test of esophageal function. Furthermore, we believe our results support a conclusion that a higher level of esophageal diagnostic information is best obtained by combined MII-EM. Future outcome studies should establish its value in patients with nonobstructive dysphagia and in prefundoplication assessment.Clinical Gastroenterology and Hepatology 03/2004; 2(3):230-6. · 5.63 Impact Factor
Article: Combined multichannel intraluminal impedance and manometry clarifies esophageal function abnormalities: study in 350 patients.[show abstract] [hide abstract]
ABSTRACT: Combined multichannel intraluminal impedance and esophageal manometry (MII-EM) is a technique that uses an FDA-approved device allowing simultaneous evaluation of bolus transit (MII) in relation to pressure changes (EM). During a 9-month period, beginning from July 2002 through March 2003, we prospectively performed combined MII-EM on all patients referred for esophageal function testing. Each patient received 10 liquid and 10 viscous swallows. Manometric findings were reported based on criteria described by Spechler and Castell for liquid swallows. MII findings were reported as having normal bolus transit if >/=80% (8/10) of liquid and >/=70% (7/10) of viscous swallows had complete bolus transit. Three-hundred fifty studies were evaluated from patients with a variety of symptoms having the following manometric diagnoses: normal manometry (125), achalasia (24), scleroderma (4), ineffective esophageal motility (IEM) (71), distal esophageal spasm (DES) (33), nutcracker esophagus (30), hypertensive lower esophageal sphincter (LES) (25), hypotensive LES (5), and poorly relaxing LES (33). None of the patients with achalasia and scleroderma had normal bolus transit. Fifty-one percent of patients with IEM and 55% of patients with DES had normal bolus transit while almost all (more than 95%) patients with normal esophageal manometry, nutcracker esophagus, poorly relaxing LES, hypertensive LES, and hypotensive LES had normal bolus transit. Dysphagia occurred most often in patients with incomplete bolus transit on MII testing. Esophageal body pressures primarily determine bolus transit with isolated LES abnormalities appearing to have little effect on esophageal function. MII clarifies functional abnormalities in patients with abnormal manometric studies.The American Journal of Gastroenterology 06/2004; 99(6):1011-9. · 7.28 Impact Factor