Quantifying esophageal peristalsis with high-resolution manometry: a study of 75 asymptomatic volunteers
ABSTRACT 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.
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ABSTRACT: Textural and rheological characteristics of foods are known to profoundly affect the swallowing process. Food technologists continue to exploit this notion in the management of symptomatic swallowing disorders (dysphagia) where novel foods are designed to elicit more reliable transport characteristics. Currently, little is understood about the relationship between food bolus formulation and its flow-induced interactions with the swallowing tract. Experimentation of a medical nature in this field is extremely challenging, and may put patients at risk. In the rheological domain the deformation fields are dissimilar to that of the biological system. In response to these limitations, quantitative assessment of bolus transport by a novel rheometric testing device is proposed. This paper describes the inspiration for a biologically-inspired robotic swallowing device to be applied to address these issues. This will allow for an improved understanding of swallowing mechanics and food design in the engineering, medical, and food technology fields.01/2013; 2(2/3/4):163 - 171. DOI:10.1504/IJBBR.2013.058719
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ABSTRACT: Functional magnetic resonance imaging (fMRI) has been recently proposed for the evaluation of the esophagus. Our aim is to assess the role of fMRI as a technique to assess morphological and functional parameters of the esophagus in patients with esophageal motor disorders and in healthy controls. Subsequently, we assessed the diagnostic efficiency of fMRI in comparison to videofluoroscopic and manometric findings in the investigation of patients with esophageal motor disorders. Considering that fMRI was shown to offer valuable information on bolus transit and on the caliber of the esophagus, variations of these two parameters in the different types of esophageal motor alterations have been assessed. fMRI, compared to manometry and videofluoroscopy, showed that a deranged or absent peristalsis is significantly associated with slower transit time and with increased esophageal diameter. Although further studies are needed, fMRI represents a promising noninvasive technique for the integrated functional and morphological evaluation of esophageal motility disorders.Gastroenterology Research and Practice 08/2011; 2011:367639. DOI:10.1155/2011/367639 · 1.50 Impact Factor