Impaired air-liquid settling during swallowing in gastroesophageal reflux disease. A digital videofluoroscopic study
Physiology and Digestive Motility Laboratory, School of Medicine, University François-Rabelais of Tours, Tours, France.Diseases of the Esophagus (Impact Factor: 1.78). 11/2008; 22(1):68-73. DOI: 10.1111/j.1442-2050.2008.00859.x
We hypothesize that the surface of the zone of air-liquid mixture in the esophagus after swallowing is the result of the esophageal gastric junction (EGJ) function or dysfunction. The aim of this study was to quantify the air-liquid components of the bolus in the esophagus and across the EGJ by means of digital videofluoroscopy sequences recorded in patients with gastroesophageal reflux disease (GERD). The patients were allocated to a Normo or a Hypo group, according to basal lower esophageal sphincter (LES) pressure. Two types of analysis were undertaken from the video sequences. For static analysis, maximal opening diameter of the LES and surfaces of air, air-barium mixture, and barium suspension were measured on two images extracted from each sequence. For dynamic analysis, transit times across the EGJ of the total bolus, air, mixture, and barium suspension were evaluated on a video sequence. For static analysis, the maximal opening diameter of the LES, air, and mixture surfaces were higher in the Hypo group. For dynamic analysis, transit time of total bolus, air, and mixture were longer in the Hypo group. The increase in mixture can be attributed to a defect in settling of both air and liquid phases in the esophagus in patients with low LES pressure and/or esophageal hypotonicity. Thus, these evaluations should provide information on the passage modalities of the bolus in esophagus and across the EGJ to assess differential diagnosis of GERD and hence to better select the most appropriate antireflux surgical procedure.
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ABSTRACT: Prolonged esophageal acid clearance, found in some patients with esophagitis, can be attributed in part to the peristaltic dysfunction observed in this population. In this study, we undertook to define the effect of commonly observed peristaltic dysfunction on volume clearance by obtaining concurrent videofluoroscopic and manometric recordings in patients with nonobstructive dysphagia or heartburn. Excellent correlation existed between the findings from the two studies. A single normal peristaltic wave resulted in 100% clearance of a barium bolus from the esophagus. At each recording site, luminal closure, as demonstrated by videofluoroscopy, coincided with the upstroke of the peristaltic pressure complex. Absent or incomplete peristaltic contractions invariably resulted in little or no volume clearance from the involved segment. Regional hypotensive peristalsis was associated with incomplete volume clearance by the mechanism of retrograde escape of barium through the region of hypotensive contraction. The regional peristaltic amplitude required to prevent retrograde escape of barium was greater in the distal compared with the proximal esophagus. The mean peristaltic amplitude associated with instances of retrograde escape was 25 mmHg in the distal esophagus compared with 12 mmHg in the proximal esophageal segments. Thus, the peristaltic dysfunction commonly seen in patients with esophagitis (failed and hypotensive peristalsis) likely leads to impaired volume clearance.Gastroenterology 02/1988; 94(1):73-80. · 16.72 Impact Factor
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ABSTRACT: This study examines the scintigraphic transit pattern in a variety of esophageal disorders. Scintigraphy was performed with a semi solid bolus and the patient in an upright position. Condensed esophageal images were obtained from which we derived the esophageal transit time. The pattern of bolus transit was graded by the duration of transit and by the presence of hold up or retrograde motion. Scintigrams were performed in 11 volunteers and 88 patients whose esophageal function had been confirmed by conventional gastroesophageal techniques. Esophageal disorders examined included achalasia (20), scleroderma (9), esophageal carcinoma (8), Barrett esophagus (5), and reflux esophagitis (27). We also examined the effects of gastroesophageal surgery on esophageal function. Transit times distinguished grossly abnormal esophageal function from normal but did not distinguish between different esophageal disorders. Graded transit patterns were a more sensitive indicator of esophageal function and permitted some differentiation between esophageal disorders and allowed evaluation of the effects of gastroesophageal surgery.European Journal of Nuclear Medicine 02/1988; 14(3):131-6. DOI:10.1007/BF00293536 · 5.38 Impact Factor
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ABSTRACT: The purposes of this study were to assess the esophageal clearance of a radioisotopic bolus in patients with symptoms of reflux and evaluate the impact of manometric abnormalities on scintigraphic esophageal transit. Esophageal clearance was assessed in a supine position and indicated by the retained radioactivity in the esophagus at 10, 20, 30 and 40 s after the ingestion of a liquid bolus labeled with 2 mCi 99 mTc-SC. The study included 214 consecutive patients with symptoms of reflux and 11 normal controls. The results were compared to the motility findings detected on manometry performed on a separate occasion. Esophageal manometry was normal in 93 patients. Nonspecific esophageal motor disorders were identified in 121 patients and were classified into: 'predominantly nonpropagated activity', 'predominantly low-amplitude peristaltic contractions' and 'miscellaneous disorders' diagnosed in 27, 47 and 47 patients, respectively. The radionuclide clearance was significantly delayed in the overall group of patients compared with that of normal controls (P < 0.001); in patients with reflux symptoms and nonspecific esophageal motor disorders compared with patients with reflux symptoms and 'normal manometry' (P < 0.01 at 20 s); and in patients with reflux symptoms and 'normal manometry' compared with the control group (P < 0.01 at 20 s). Abnormal radioisotope clearances were detected in 88% of patients with 'predominantly nonpropagated activity', in 70% of patients with 'predominantly low-amplitude peristaltic contractions' and in 57% of patients with 'miscellaneous disorders'. Radioisotopic esophageal clearance abnormalities are frequently observed in patients with reflux symptoms and are more likely to be associated to hypomotility disorders, i.e. nonpropagated motor activity or low-amplitude contractions.Diseases of the Esophagus 02/2004; 17(3):218-22. DOI:10.1111/j.1442-2050.2004.00411.x · 1.78 Impact Factor
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