The vastly enhanced spatial resolution of high-resolution manometry (HRM) makes it possible to simultaneous monitor contractile activity over the entire length of the esophagus. The aim of this investigation was to define the essential features of esophageal peristalsis in novel HRM paradigms and establish their normative values. Ten 5-ml water swallows were recorded in each of 75 asymptomatic controls with a solid-state manometric assembly incorporating 36 circumferential sensors spaced at 1-cm intervals positioned to record from the hypopharynx to the stomach. The data set was then subjected to intensive computational analysis to distill out the essential characteristics of normal peristalsis. Esophageal peristalsis was conceptualized in terms of a proximal contraction, a distal contraction, and a transition zone separating the two. Each contractile segment was quantified in length and then normalized among subjects to summarize focal fluctuation of contractile amplitude and propagation velocity. Furthermore, the temporal and spatial characteristics of the transition zone separating the proximal and distal contraction were quantified. For each paradigm, graphics were developed, establishing median values along with the 5th to 95th percentile range of observed variation. In addition, the synchronization between peristalsis and esophagogastric junction relaxation was analyzed using a novel concept of the outflow permissive pressure gradient. We performed a detailed analysis of esophageal peristalsis aimed at quantifying its essential features and, in so doing, devised new paradigms for the quantification of peristaltic function that will hopefully optimize the utility of HRM in clinical and investigative studies.
"However, peak pharyngeal pressure only shows the highest pressure for a short time and it is difficult to say that it represents the contractility of the whole pharynx. CI was recently developed as a way of quantifying the overall vigor of contraction, and it is known to be sensitive in delineating abnormalities involving sustained or hypertensive esophageal contractions.13 In this study, we tried to make an adequate tool for the evaluation of pharyngeal and UES contractility based on the simultaneous examination of VFSE and HRM. "
[Show abstract][Hide abstract] ABSTRACT: Background/Aims
The purpose of this study was to determine important manometric metrics for the analysis of pharyngeal and upper esophageal sphincter (UES) function and to investigate the effect of viscosity and other confounding factors on manometric results.
Manometric studies were performed on 26 asymptomatic volunteers (12 men and 14 women; age, 19–81 years). The manometric protocol included 5 water swallows (5 mL), 5 barium swallows (5 mL) and 5 yogurt swallows (5 mL). Evaluation of high-resolution manometry parameters including basal pressure of the UES, mesopharyngeal contractile integral (mesopharyngeal CI, mmHg · cm · sec), CI of the hypopharynx and UES (hypopharyngeal CI), relaxation interval of UES, median intrabolus pressure and nadir pressure at UES was performed using MATLAB.
Mesopharyngeal CIs for barium and yogurt swallows were significantly lower than those for water swallows (both P < 0.05). Hypopharyngeal CIs for water swallows were significantly lower than those for barium swallows (P = 0.004), and median bolus pressure at UES for barium swallows was significantly higher than that for water and yogurt swallows (both P < 0.05). Furthermore, hypopharyngeal CI and median intrabolus pressure at UES were significantly related to age for 3 swallows (all P < 0.01 and P < 0.05, respectively). A significant negative correlation was also noted between nadir pressure at UES and age for water and yogurt swallows (all P < 0.05).
Manometric measurement of the pharynx and UES varies with respect to viscosity. Moreover, age could be a confounding variable in the interpretation of pharyngeal manometry.
Journal of neurogastroenterology and motility 05/2014; 20(3). DOI:10.5056/jnm14021 · 2.30 Impact Factor
"Recent HRM studies have shown that esophageal peristalsis actually comprises 2 distinct contractile waves, corresponding to distinct muscle types and neural control mechanisms of the proximal and distal esophagus.10-13 The TZ represents the region of spatiotemporal merger between the 2 contractile waves.11,14 Two case reports have documented instances in which TZ defects identified with HRM pressure topography were associated with impaired bolus transit across the TZ.15,16 TZ defects represent a distinct esophageal motility disorder that should be considered in the evaluation of unexplained dysphagia.5 "
[Show abstract][Hide abstract] ABSTRACT: High-resolution manometry (HRM), with a greatly increased number of recording sites and decreased spacing between sites, allows evaluation of the dynamic simultaneous relationship between intrabolus pressure (IBP) and esophagogastric junction (EGJ) relaxation pressure. We hypothesized that bolus transit may occur when IBP overcomes integrated relaxation pressure (IRP) and analyzed the relationships between peristalsis pattern and the discrepancy between IBP and IRP in patients with dysphagia.
Twenty-two dysphagia patients with normal EGJ relaxation were examined with a 36-channel HRM assembly. Each of the 10 examinations was performed with 20 and 30 mmHg pressure topography isobaric contours, and findings were categorized based on the Chicago classification. We analyzed the relationships between peristalsis pattern and the discrepancy between IBP and IRP.
Twenty-two patients were classified by the Chicago classification: 1 patient with normal EGJ relaxation and normal peristalsis, 8 patients with intermittent hypotensive peristalsis and 13 patients with frequent hypotensive peristalsis. A total of 220 individual swallows were analyzed. There were no statistically significant relationships between peristalsis pattern and the discrepancy between IBP and IRP on the 20 or 30 mmHg isobaric contours.
Peristalsis pattern was not associated with bolus transit in patients with dysphagia. However, further controlled studies are needed to evaluate the relationship between bolus transit and peristalsis pattern using HRM with impedance.
Journal of neurogastroenterology and motility 01/2014; 20(1):74-8. DOI:10.5056/jnm.2014.20.1.74 · 2.30 Impact Factor
"We also defined the lower margin of the UES and esophagogastric junction (EGJ) from resting state of esophagus to differentiate proximal and distal esophageal contraction from UES and EGJ as Ghosh et al12 did.13,14 The PCI and the DCI werecalculated with 30 mmHg isobaric contour pressure levels. "
[Show abstract][Hide abstract] ABSTRACT: Globus is a foreign body sense in the throat without dysphagia, odynophagia, esophageal motility disorders, or gastroesophageal reflux. The etiology is unclear. Previous studies suggested that increased upper esophageal sphincter pressure, gastroesophageal reflux and hypertonicity of esophageal body were possible etiologies. This study was to quantify the upper esophageal sphincter (UES) pressure, contractile front velocity (CFV), proximal contractile integral (PCI), distal contractile integral (DCI) and transition zone (TZ) in patient with globus gastroesophageal reflux disease (GERD) without globus, and normal controls to suggest the correlation of specific high-resolution manometry (HRM) findings and globus.
Fifty-seven globus patients, 24 GERD patients and 7 normal controls were studied with HRM since 2009. We reviewed the reports, and selected 5 swallowing plots suitable for analysis in each report, analyzed each individual plot with ManoView. The 5 parameters from each plot in 57 globus patients were compared with that of 24 GERD patients and 7 normal controls.
There was no significant difference in the UES pressure, CFV, PCI and DCI. TZ (using 30 mmHg isobaric contour) in globus showed significant difference compared with normal controls and GERD patients. The median values of TZ were 4.26 cm (interquartile range [IQR], 2.30-5.85) in globus patients, 5.91 cm (IQR, 3.97-7.62) in GERD patients and 2.26 cm (IQR, 1.22-2.92) in normal controls (P = 0.001).
HRM analysis suggested that UES pressure, CFV, PCI and DCI were not associated with globus. Instead increased length of TZ may be correlated with globus. Further study comparing HRM results in globus patients within larger population needs to confirm their correlation.
Journal of neurogastroenterology and motility 10/2013; 19(4):473-8. DOI:10.5056/jnm.2013.19.4.473 · 2.30 Impact Factor
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