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Miah I, Wong T, Zeki S, Jafari J. The Multichannel Intraoesophageal Impedance Transit Concept. Cureus 2024; 16:e73396. [PMID: 39659358 PMCID: PMC11631163 DOI: 10.7759/cureus.73396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2024] [Indexed: 12/12/2024] Open
Abstract
Introduction/aims The multichannel intraoesophageal impedance transit (MIIT) is a new clinical concept that is being introduced to measure the oesophageal transit during a 24-hour multichannel impedance-pH (MII-pH) study. Methods MIIT was tested in a case-control study between January 2020 and December 2023. A laboratory test was first conducted to determine the saline baseline impedance (SBI) using MII-pH catheters. SBI was later used to reference the oesophageal transit of saline during the MIIT test. In the MIIT test, patients rapidly drank 200 ml of saline within 20 seconds. The saline transit was identified by the temporal impedance changes from the oesophageal mucosal baseline impedance (MBI) to the approximate SBI level. The duration of SBI was recorded from multiple impedance sensors in the proximal, mid and distal oesophagus which form the MIIT. The regional MIIT were correlated to the Hospital Odynophagia Dysphagia Questionnaire (HODQ) scores for clinical dysphagia and severity. Regional MIIT were also compared between achalasia patients (case group) and non-achalasia patients (control group) based on high-resolution manometry (HRM) and barium swallow (BS) diagnosis. Descriptive statistics, t-test and chi-squared test compared the MIIT with respect to HODQ scores, HRM and BS outcomes. Receiver operating characteristic curves with Youden's J indices determined the optimal MIIT cut-off threshold for achalasia. This research was approved by the North West Haydock NHS Health Research Authority (REC 18/NW/0120) and the Integrated Research Application System (Project ID: 333800). Results Nine hundred and eleven patients undertook the MIIT test prospectively to HRM study (females 554, mean age 50.9 years). Three hundred and thirty-three patients (36.6%) additionally underwent the BS study (the BS-HRM diagnostic concordance outcome was 83.8%). Oesophageal luminal transit of saline was identifiable during MIIT and found to be significantly lower than the MBI (t-value=3.59-9.07, p<0.001). Regional MIIT increased with higher dysphagia severity (r≈0.33, p<0.001) and positive HODQ scores for clinical dysphagia (t-value=6.18-6.30, p<0.001). Similarly, prolonged regional MIIT was observed in achalasia patients based on BS study diagnosis (t-values: 9.86-11.2, p<0.001) and HRM study diagnosis (t-values: 23-27.4, p<0.001). Patients with concordant BS-HRM study for achalasia also showed prolonged regional MIIT (t-value: 13.9-16.4, p<0.001). The optimal MIIT of the distal oesophagus for achalasia diagnosis is between 4.05 minutes and 5.45 minutes (sensitivity: 73.8-100%, positive predictive values: 90.5-94.4%). MIIT thresholds for achalasia show higher concordance to the HRM study than the BS study at 4.05 minutes (χ2=4.69, p<0.030). Conclusions The MIIT concept was demonstrated to be a simple and effective transit assessment that showed exceptional reliability to BS and HRM studies. The MIIT technique can be easily incorporated into the MII-pH investigation without causing additional risk or burden to patients.
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Affiliation(s)
- Ismail Miah
- Faculty of Life Sciences and Medicine, King's College London, London, GBR
- Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, GBR
| | - Terry Wong
- Faculty of Life Sciences and Medicine, King's College London, London, GBR
- Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, GBR
| | - Sebastian Zeki
- Faculty of Life Sciences and Medicine, King's College London, London, GBR
- Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, GBR
| | - Jafar Jafari
- Faculty of Life Sciences and Medicine, King's College London, London, GBR
- Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, GBR
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Association of Bolus Transit Time on Barium Esophagram With Esophageal Peristalsis on High-resolution Manometry and Nonobstructive Dysphagia. J Clin Gastroenterol 2022; 56:748-755. [PMID: 34999642 DOI: 10.1097/mcg.0000000000001659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 12/03/2021] [Indexed: 12/10/2022]
Abstract
GOAL The goal of this study was to correlate upright and prone bolus transit time (BTT) on barium esophagography (BE) with esophageal peristalsis on high-resolution manometry (HRM) and self-reported dysphagia in patients with normal lower esophageal sphincter parameters on HRM. BACKGROUND BTT on BE could be the gold standard for assessing the effectiveness of esophageal peristalsis if it can be quantified. MATERIALS AND METHODS Patients with normal lower esophageal sphincter parameters and standard-protocol BE from 2017 to 2020 were included. Patients were divided, based on the number of normal swallows (distal contractile integral >450 mm Hg-s-cm), into 11 groups (10 normal swallows to 0 normal swallows). Liquid barium swallows in prone position were objectively evaluated for prone BTT. Patients reported difficulty in swallowing on a scale from 0 (none) to 4 (very severe). Fractional polynomial and logistic regression analysis were used to study the association (along with the rate of change) between BTT, peristalsis, and dysphagia. RESULTS A total of 146 patients were included. Prone BTT increased as the number of normal swallows decreased ( P <0.001). Two deflection points were noted on the association between peristalsis and prone BTT at 50% normal swallows, 40 seconds and 30% normal swallows, 80 seconds, after which peristaltic function declined independently of prone BTT. Patients with prone BTT>40 seconds had nearly 6-fold higher odds of 0% normal swallows on HRM than patients with prone BTT<40 seconds ( P =0.002). Increasing prone BTT was associated with increasing dysphagia grades 1 and 2 ( P ≤0.036). CONCLUSIONS Esophageal motility can be quantified by BE. Prone BTT correlates with the proportion of normal esophageal swallows and dysphagia.
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Burton L, Beattie J, Falk GL, Van der Wall H, Coman W. The burden of gastroesophageal reflux disease on the cost of managing chronic diseases in Australia. The need for a new diagnostic and management paradigm. Chronic Illn 2022; 18:343-355. [PMID: 33070630 DOI: 10.1177/1742395320966373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Chronic disease poses a major problem for the Australian healthcare system as the leading cost-burden and cause of death. Gastroesophageal reflux disease (GORD) typifies the problems with a growing prevalence and cost. We hypothesise that a scintigraphic test could optimise the diagnosis, especially in problematic extraoesophageal disease. MATERIALS AND METHODS Data was collected from 2 groups of patients. Patients undergoing fundoplication for severe GORD (n = 30) and those with atypical symptoms (n = 30) were studied by scintigraphy and 24-hour oesophageal pH, impedance and manometry. RESULTS Mean age of cohort was 55.8 years with 40 females and 20 males. Body mass index was a mean of 28.3. DeMeester score was normal in 12/60 with atypical symptoms and abnormal in the rest. Good correlation was shown between scintigraphy and impedance, manometry and distal pH readings. Pulmonary aspiration was shown in 25/60 (15 with atypical symptoms) and LPR in 20/30. Several impedance, manometric and scintigraphic finding were good predictors of lung aspiration of refluxate. CONCLUSION Scintigraphy provides a good tool for screening patients with typical and atypical symptoms of GORD. It is well correlated with the standard methods for the diagnosis and provides visual evidence of LPR and lung aspiration.
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Affiliation(s)
- Leticia Burton
- CNI Molecular Imaging & University of Notre Dame, Sydney, Australia
| | | | - Gregory L Falk
- Sydney Heartburn Clinic, Concord Hospital & University of Sydney, Sydney, Australia
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Lyngby JG, Haines JM, Guess SC. Use of a videofluoroscopic feeding evaluation to guide management of dogs with congenital idiopathic megaoesophagus. Vet Med Sci 2022; 8:1434-1442. [PMID: 35476311 PMCID: PMC9297758 DOI: 10.1002/vms3.821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Evidence‐based guidelines for determining dietary management in dogs with megaoesophagus are lacking. Objectives This study looked to compare oesophageal clearance times (ECT) of liquid and two food consistencies using a contrast videofluoroscopy feeding evaluation, and to assess if recommendations made based on findings could improve regurgitation and quality of life in dogs with congenital megaoesophagus. Methods Twenty‐one dogs with congenital megaoesophagus and nine healthy dogs received liquid, slurry, and meatball diets containing barium while in an upright position. Follow‐up was performed to determine response to recommendations. Results Healthy dogs had significantly shorter median ECT for all consistencies (p < 0.001). In the megaoesophagus group, ECT varied by consistency and individual. The number of dogs in the megaoesophagus group with complete clearance was four (median ECT 10 min) for liquid, five (median ECT 5 min) for slurry, and two (median ECT 5 and 30 min, respectively) for meatballs. Partial clearance was seen in 11 dogs (median clearance 25%) with liquid, seven with slurry (median clearance 50%), and five with meatballs (median clearance 60%). Recommendations included altering current medications (13/21 dogs), diet consistency (6/21), time upright (12/21), water delivery (21/21), and adding activity (7/21). Regurgitation episodes/week decreased significantly from 5.5 to 2.5 (p < 0.001) at follow‐up 3–5 weeks post‐evaluation, with 95% of owners reporting improvement in quality of life. Seventy percent were alive 46–777 days after last recheck. Three dogs died from megaoesophagus associated complications (median survival 461 days after diagnosis). Conclusions The findings of this study suggest that a videofluoroscopic feeding evaluation may help guide management of dogs with congenital megaoesophagus.
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Affiliation(s)
- Janne G Lyngby
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
| | - Jillian M Haines
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
| | - Sarah C Guess
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington, USA
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Heitmann PT, Mohd Rosli R, Maslen L, Wiklendt L, Kumar R, Omari TI, Wattchow D, Costa M, Brookes SJ, Dinning PG. High-resolution impedance manometry characterizes the functional role of distal colonic motility in gas transit. Neurogastroenterol Motil 2022; 34:e14178. [PMID: 34076936 DOI: 10.1111/nmo.14178] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 04/05/2021] [Accepted: 04/28/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The colonic motor patterns associated with gas transit are poorly understood. This study describes the application of high-resolution impedance manometry (HRiM) in the human colon in vivo to characterize distal colonic motility and gas transit; (a) after a meal and (b) after intraluminal gas insufflation into the sigmoid colon. METHODS HRiM recordings were performed in 19 healthy volunteers, with sensors positioned from the distal descending colon to the proximal rectum. Protocol 1 (n = 10) compared pressure and impedance prior to and after a meal. Protocol 2 (n = 9) compared pressure and impedance before and after gas insufflation into the sigmoid colon (60 mL total volume). KEY RESULTS Both the meal and gas insufflation resulted in an increase in the prevalence of the 2-8/minute "cyclic motor pattern" (meal: (t(9) = -6.42, P<0.001); gas insufflation (t(8) = -3.13, P = 0.01)), and an increase in the number of antegrade and retrograde propagating impedance events (meal: Z = -2.80, P = 0.005; gas insufflation Z = -2.67, P = 0.008). Propagating impedance events temporally preceded antegrade and retrograde propagating contractions, representing a column of luminal gas being displaced ahead of a propagating contraction. Three participants reported an urge to pass flatus and/or flatus during the studies. CONCLUSIONS AND INFERENCES Initiation of the 2-8/minute cyclic motor pattern in the distal colon occurs both following a meal and/or as a localized sensorimotor response to gas. The near-absence of a flatal urge and the temporal association between propagating contractions and gas transit supports the hypothesis that the 2-8/minute cyclic motor pattern acts as a physiological "brake" modulating rectal filling.
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Affiliation(s)
- Paul T Heitmann
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Department of Gastroenterology and Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Reizal Mohd Rosli
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Lyn Maslen
- Department of Gastroenterology and Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Lukasz Wiklendt
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Raghu Kumar
- Department of Gastroenterology and Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Taher I Omari
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - David Wattchow
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Department of Gastroenterology and Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Marcello Costa
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Simon J Brookes
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Phil G Dinning
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Department of Gastroenterology and Surgery, Flinders Medical Centre, Adelaide, Australia
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Tack J, Pauwels A, Roman S, Savarino E, Smout A. European Society for Neurogastroenterology and Motility (ESNM) recommendations for the use of high-resolution manometry of the esophagus. Neurogastroenterol Motil 2021; 33:e14043. [PMID: 33274525 DOI: 10.1111/nmo.14043] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/30/2020] [Accepted: 11/02/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Several patients in gastroenterology practice present with esophageal symptoms, and in case of normal endoscopy with biopsies, high-resolution manometry (HRM) is often the next step. Our aim was to develop a European consensus on the clinical application of esophageal HRM, to offer the clinician guidance in selecting patients for HRM and using its results to optimize clinical outcome. METHODS A Delphi consensus was initiated with 38 multidisciplinary experts from 16 European countries who conducted a literature summary and voting process on 71 statements. Quality of evidence was evaluated using grading of recommendations assessment, development, and evaluation (GRADE) criteria. Consensus (defined as >80% agreement) was reached for 33 statements. RESULTS The process generated guidance on when to consider esophageal HRM, how to perform it, and how to generate the report. The Delphi process also identified several areas of uncertainty, such as the choice of catheters, the duration of fasting and the position in which HRM is performed, but recommended to perform at least 10 5-ml swallows in supine position for each study. Postprandial combined HRM impedance is considered useful for diagnosing rumination. There is a large lack of consensus on treatment implications of HRM findings, which is probably the single area requiring future targeted research. CONCLUSIONS AND INFERENCES A multinational and multidisciplinary group of European experts summarized the current state of consensus on technical aspects, indications, performance, analysis, diagnosis, and therapeutic implications of esophageal HRM.
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Affiliation(s)
- Jan Tack
- Division of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Ans Pauwels
- Universitaire Ziekenhuis Gasthuisberg, Leuven, Belgium
| | - Sabine Roman
- Department of Digestive Physiology, Hospices Civils de Lyon, Lyon University, Lyon, France
| | | | - André Smout
- Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
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Dent J, Deloose E, Dinning P, Corsetti M, Rommel N, Tack J, Wiklendt L, Papageorgiou AW, Arkwright JW. Manometric demonstration of duodenal/jejunal motor function consistent with the duodenal brake mechanism. Neurogastroenterol Motil 2020; 32:e13835. [PMID: 32167632 DOI: 10.1111/nmo.13835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 01/25/2020] [Accepted: 01/28/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND High-resolution manometric studies below the stomach are rare due to technical limitations of traditional manometry catheters. Consequently, specific motor patterns and their impact on gastric and small bowel function are not well understood. High-resolution manometry was used to record fed-state motor patterns in the antro-jejunal segment and relate these to fasting motor function. METHODS Antro-jejunal pressures were monitored in 15 healthy females using fiber-optic manometry (72 sensors at 1 cm intervals) before and after a high-nutrient drink. KEY RESULTS Postprandial motility showed a previously unreported transition point 18.8 cm (range 13-28 cm) beyond the antro-pyloric junction. Distal to the transition, a zone of non-propagating, repetitive pressure events (11.5 ± 0.5 cpm) were dominant in the fed state. We have named this activity, the duodeno-jejunal complex (DJC). Continuous DJC activity predominated, but nine subjects also exhibited intermittent clusters of DJC activity, 7.4 ± 4.9/h, lasting 1.4 ± 0.55 minutes, and 3.8 ± 1.2 minutes apart. DJC activity was less prevalent during fasting (3.6 ± 3.3/h; P = .04). 78% of fed and fasting state propagating antro-duodenal pressure events terminated proximally or at the transition point and were closely associated with DJC clusters. CONCLUSIONS AND INFERENCES High-resolution duodeno-jejunal manometry revealed a previously unrecognized transition point and associated motor pattern extending into the jejunum, consistent with the duodenal brake previously identified fluoroscopically. Timing suggests DJC activity is driven by chyme stimulating duodenal mucosal chemosensors. These findings indicate that the duodenum and proximal jejunum consists of two major functional motor regions.
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Affiliation(s)
- John Dent
- Department of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Eveline Deloose
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Philip Dinning
- Department of Gastroenterology & Surgery, Flinders Medical Centre, Adelaide, SA, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Maura Corsetti
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium.,National Institute for Health Research, Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - Nathalie Rommel
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium.,Experimental Oto-Rhino-Laryngology, University of Leuven, Leuven, Belgium
| | - Jan Tack
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Lukasz Wiklendt
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
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Ivashkin VT, Mayev IV, Trukhmanov AS, Storonova OA, Abdulkhakov SA, Andreev DN, Bordin DS, Valitova ER, Klyaritskaya IL, Krivoy VV, Kucheryavyi YA, Lapina TL, Morozov SV, Sablin OA, Semenikhina EV, Uspenskiy YP, Sheptulin AA. Recommendations of the Russian Gastroenterological Association on Clinical Use of High-Resolution Manometry in Diagnosis of Esophageal Disorders. RUSSIAN JOURNAL OF GASTROENTEROLOGY, HEPATOLOGY, COLOPROCTOLOGY 2020; 30:61-88. [DOI: 10.22416/1382-4376-2020-30-3-61-88] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Aim. Current recommendations of the Russian Gastroenterological Association on clinical use of high-resolution manometry in diagnosis of esophageal disorders are intended to assist in clinical decision making, terminology standardisation and interpretation of clinical data.Key points. In 2018, a joint meeting of the Russian Gastroenterological Association and Russian Neurogastroenterology and Motility Group approved unified terminology and classification of esophageal motor function disorders for high-resolution manometry diagnosis.Gastrointestinal patient complaints typically concern esophageal disorders such as dysphagia, regurgitation, heart-burn, chest pain or belching. To exclude erosive and ulcerative lesions, eosinophilic esophagitis and organic changes, esophagogastroduodenoscopy and biopsy are recommended in pre-treatment. Upon excluding mucosal lesions and esophageal lumen obstruction as causal for symptoms, use of high-resolution manometry is recommended. This method of esophageal examination has become the “gold standard” in diagnosis of motor disorders.High-resolution manometry enables detailed investigation of integral quantitative and qualitative characteristics of esophagus motor function and specific related disorders, analysis of esophageal contractile propagation and strictly coordinated synchronous peristalsis of upper esophageal sphincter, esophagus and lower esophageal sphincter, which malfunction may provoke development of achalasia, esophagospasm, hiatal hernia, ineffective eso pha geal motility and other motor disorders.Conclusion. High-resolution manometry is a relatively new method for study of esophagus motor function gaining increasingly wide application in clinical practice. It enables a medical professional to obtain evidence that may critically affect the choice of optimal patient care strategy and effective treatment. Current recommendations are based on an extensive review of up-to-date information and will be updated with new corpus of clinical data and assessment emerging in evidential medicine to provide gastroenterologists country-wide with latest scientific and practical guidelines.
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Affiliation(s)
- V. T. Ivashkin
- Sechenov First Moscow State Medical University (Sechenov University)
| | - I. V. Mayev
- Moscow State University of Medicine and Dentistry
| | - A. S. Trukhmanov
- Sechenov First Moscow State Medical University (Sechenov University)
| | - O. A. Storonova
- Sechenov First Moscow State Medical University (Sechenov University)
| | | | | | - D. S. Bordin
- Moscow State University of Medicine and Dentistry; Loginov Moscow Clinical Scientific Center; Tver State Medical University
| | | | | | | | | | - T. L. Lapina
- Sechenov First Moscow State Medical University (Sechenov University)
| | - S. V. Morozov
- Federal Research Center for Nutrition, Biotechnology and Food Safety
| | - O. A. Sablin
- Nikiforov All-Russian Center for Emergency and Radiation Medicine
| | | | - Yu. P. Uspenskiy
- Saint-Petersburg State Pediatric Medical University; Pavlov First Saint-Petersburg State Medical University
| | - A. A. Sheptulin
- Sechenov First Moscow State Medical University (Sechenov University)
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Gong EJ, Choi K, Jung KW, Pandolfino JE, Kim DY, Yoon IJ, Seo SY, Koo HS, Na HK, Ahn JY, Lee JH, Choi KD, Kim DH, Song HJ, Lee GH, Jung HY, Myung SJ, Kim N, Joo S. New parameter for quantifying bolus transit with high-resolution impedance manometry: A comparison with simultaneous esophagogram. Neurogastroenterol Motil 2020; 32:e13847. [PMID: 32299145 DOI: 10.1111/nmo.13847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/19/2020] [Accepted: 03/18/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Esophageal bolus transit can be assessed using esophagogram or high-resolution impedance manometry (HRIM). The three-dimensional volume of inverted impedance (VII) has been developed to quantify the residual bolus between each swallow through spatiotemporal analysis. However, this novel metric has not been validated against simultaneous esophagogram. METHODS A total of nine healthy volunteers (Seven males, aged 19-45 years) were prospectively evaluated with HRIM and barium esophagogram. In addition, 21 symptomatic patients (12 males, aged 20-85 years) without major motility disorder were also included. The VII was estimated from HRIM data using MATLAB program and was compared with residual bolus volume in the esophagus estimated from simultaneous esophagogram. KEY RESULTS A total of 80 swallows (24 in controls and 56 in patients) were analyzed. Results from the VII method were concordant with the bolus transit pattern estimated from the esophagogram in 91.3% (73/80) of swallows. The correlation between quantitative data from VII and the volume of residual bolus estimated from esophagogram was strong in both groups with a Pearson's correlation coefficient of 0.805 for healthy volunteers and 0.730 for symptomatic patients. The intraclass correlation coefficient of VII between the three swallows within a subject was 0.901 in healthy subjects and 0.705 in patients, indicating a modest reliability of this method. CONCLUSIONS AND INFERENCES The newly developed VII method is a reliable method in assessing residual bolus volume in the esophagus based on comparison with bolus volume estimated from simultaneous esophagogram.
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Affiliation(s)
- Eun Jeong Gong
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Kyungmin Choi
- Department of Biomedical Engineering, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - John E Pandolfino
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Do Yeon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Ja Yoon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So Young Seo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Sook Koo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Nayoung Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Korea
| | - Segyeong Joo
- Department of Biomedical Engineering, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Haines JM, Khoo A, Brinkman E, Thomason JM, Mackin AJ. Technique for Evaluation of Gravity-Assisted Esophageal Transit Characteristics in Dogs with Megaesophagus. J Am Anim Hosp Assoc 2019; 55:167-177. [PMID: 31099601 DOI: 10.5326/jaaha-ms-6711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Movement of food material in the esophagus during upright feeding in dogs with megaesophagus (ME) is poorly characterized. A standardized contrast videofluoroscopy technique was used to evaluate esophageal transit characteristics in dogs with ME while in an upright position. Twelve dogs with ME (congenital, acquired idiopathic, or secondary to myasthenia gravis) were placed in an upright position using Bailey chairs and given liquid barium, canned food meatballs, and their normal diet consistency if different than meatballs. Passage of ingesta was videofluoroscopically evaluated by direct observation and change in ingesta area as determined by manual tracing or barium column product calculations. Significant individual variation was seen. Complete esophageal clearance of liquid was seen in four dogs, and complete clearance of meatballs in three dogs, with a median time of 5 min for both. Two of seven dogs fed a slurry diet had complete clearance by 10 min. No significant difference was found between area calculated via tracing or barium column product. Based on imaging results, alterations in food consistency, duration upright, or medication were recommended for nine dogs. In dogs with ME accustomed to a Bailey chair, contrast videofluoroscopy was technically straightforward and allowed for more specific physician-guided management recommendations.
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Affiliation(s)
- Jillian M Haines
- From the Department of Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington (J.M.H.); Upstate Veterinary Specialties, Latham, New York (A.K.); and Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi (E.B., J.M.T., A.J.M.)
| | - Alison Khoo
- From the Department of Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington (J.M.H.); Upstate Veterinary Specialties, Latham, New York (A.K.); and Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi (E.B., J.M.T., A.J.M.)
| | - Erin Brinkman
- From the Department of Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington (J.M.H.); Upstate Veterinary Specialties, Latham, New York (A.K.); and Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi (E.B., J.M.T., A.J.M.)
| | - John M Thomason
- From the Department of Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington (J.M.H.); Upstate Veterinary Specialties, Latham, New York (A.K.); and Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi (E.B., J.M.T., A.J.M.)
| | - Andrew J Mackin
- From the Department of Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington (J.M.H.); Upstate Veterinary Specialties, Latham, New York (A.K.); and Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, Mississippi (E.B., J.M.T., A.J.M.)
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11
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Chan ED, Wooten WI, Hsieh EW, Johnston KL, Shaffer M, Sandhaus RA, van de Veerdonk F. Diagnostic evaluation of bronchiectasis. RESPIRATORY MEDICINE: X 2019. [DOI: 10.1016/j.yrmex.2019.100006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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12
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Dinning PG. A new understanding of the physiology and pathophysiology of colonic motility? Neurogastroenterol Motil 2018; 30:e13395. [PMID: 29971850 DOI: 10.1111/nmo.13395] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/18/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND In recent years, high-resolution manometry has been used in an attempt to gain a greater insight into the physiology/pathophysiology of colonic contractile activity in healthy adults and patients with colonic motility disorders. New colonic motor patterns have been identified and characterized, however, the clinical significance of these findings remains undetermined. PURPOSE This review will assess the current literature on colonic high-resolution manometry and determine if this procedure has advanced our understanding of colonic motility. The limitations, future directions, and the potential of this technique to assess the effects of treatment upon colonic motor patterns will also be discussed.
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Affiliation(s)
- P G Dinning
- The Department of Gastroenterology & Surgery, Flinders Medical Centre & the College of Medicine and Public Health & Centre for Neuroscience, Flinders University, Bedford Park, SA, Australia
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13
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Omari T, Connor F, McCall L, Ferris L, Ellison S, Hanson B, Abu-Assi R, Khurana S, Moore D. A study of dysphagia symptoms and esophageal body function in children undergoing anti-reflux surgery. United European Gastroenterol J 2018; 6:819-829. [PMID: 30023059 PMCID: PMC6047286 DOI: 10.1177/2050640618764936] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/22/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The role of high-resolution esophageal impedance manometry (HRIM) for establishing risk for dysphagia after anti-reflux surgery is unclear. We conducted a prospective study of children with primary gastroesophageal reflux (GER) disease, for whom symptoms of dysphagia were determined pre-operatively and then post-operatively and we examined for features that may predict post-operative dysphagia. METHODS Thirteen children (aged 6.8-15.5 years) undergoing work-up prior to 360o Nissen fundoplication were included in the study. A dysphagia score assessed symptoms at pre-operative study and post-operatively (mean 1.4 years). A HRIM procedure recorded 5-ml liquid, 5-ml viscous and 2-cm solid boluses. We assessed esophageal motility, esophago-gastric junction (EGJ) morphology, EGJ contractility and pressure-flow variables indicative of bolus distension pressures and bolus clearance pressures. A composite pressure-flow index score was also derived. RESULTS Pre-operative pressure-flow index was positively correlated with post-operative dysphagia score (viscous bolus r = 0.771, p < 0.005). Of three variables that comprise the pressure-flow index, the ramp pressure measured during bolus clearance was the main driver of the effect seen (viscous bolus r = 0.819, p < 0.005). CONCLUSIONS In order to mitigate symptoms in relation to anti-reflux surgery, dysphagia symptoms and esophageal function need to be pre-operatively assessed. In patients with normal motility, an elevated pressure-flow index may predict post-operative dysphagia.
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Affiliation(s)
- T Omari
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Centre for Neuroscience, Flinders University, Adelaide, Australia
| | - F Connor
- Department of Gastroenterology, Royal Children's Hospital, Brisbane, Australia
| | - L McCall
- Gastroenterology Unit, Women's & Children's Hospital, Adelaide, Australia
| | - L Ferris
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Centre for Neuroscience, Flinders University, Adelaide, Australia
| | - S Ellison
- Gastroenterology Unit, Women's & Children's Hospital, Adelaide, Australia
| | - B Hanson
- UCL Mechanical Engineering, University College London, London, UK
| | - R Abu-Assi
- Gastroenterology Unit, Women's & Children's Hospital, Adelaide, Australia
| | - S Khurana
- Paediatric Surgery & Urology, Women's & Children's Hospital, Adelaide, Australia
| | - D Moore
- Gastroenterology Unit, Women's & Children's Hospital, Adelaide, Australia
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14
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Anti-reflux procedures: complications, radiologic findings, and surgical and gastroenterologic perspectives. Abdom Radiol (NY) 2018; 43:1308-1318. [PMID: 29302737 DOI: 10.1007/s00261-017-1446-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This article provides an overview of the current surgical anti-reflux procedures and their imaging findings, as well as the surgical complications. Accurate and timely clinical assessment requires an engaged radiologist fluoroscopist who understands the perspectives of their interdisciplinary colleagues, including the surgeon and gastroenterologist. The complex pathophysiology calls for an interdisciplinary approach, and the radiologist needs to tailor their evaluation to answer the specific questions posed by their clinical colleagues and by the presenting symptomatology.
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15
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Mohd Rosli R, Leibbrandt RE, Wiklendt L, Costa M, Wattchow DA, Spencer NJ, Brookes SJ, Omari TI, Dinning PG. Discriminating movements of liquid and gas in the rabbit colon with impedance manometry. Neurogastroenterol Motil 2018; 30:e13263. [PMID: 29235207 DOI: 10.1111/nmo.13263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/14/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND High-resolution impedance manometry is a technique that is well established in esophageal motility studies for relating motor patterns to bolus flow. The use of this technique in the colon has not been established. METHODS In isolated segments of rabbit proximal colon, we recorded motor patterns and the movement of liquid or gas boluses with a high-resolution impedance manometry catheter. These detected movements were compared to video recorded changes in gut diameter. Using the characteristic shapes of the admittance (inverse of impedance) and pressure signals associated with gas or liquid flow we developed a computational algorithm for the automated detection of these events. KEY RESULTS Propagating contractions detected by video were also recorded by manometry and impedance. Neither pressure nor admittance signals alone could distinguish between liquid and gas transit, however the precise relationship between admittance and pressure signals during bolus flow could. Training our computational algorithm upon these characteristic shapes yielded a detection accuracy of 87.7% when compared to gas or liquid bolus events detected by manual analysis. CONCLUSIONS & INFERENCES Characterizing the relationship between both admittance and pressure recorded with high-resolution impedance manometry can not only help in detecting luminal transit in real time, but also distinguishes between liquid and gaseous content. This technique holds promise for determining the propulsive nature of human colonic motor patterns.
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Affiliation(s)
- R Mohd Rosli
- Department of Gastroenterology & Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia.,College of Medicine and Public Health & Centre for Neuroscience, Flinders University, Bedford Park, South Australia, Australia
| | - R E Leibbrandt
- College of Medicine and Public Health & Centre for Neuroscience, Flinders University, Bedford Park, South Australia, Australia
| | - L Wiklendt
- College of Medicine and Public Health & Centre for Neuroscience, Flinders University, Bedford Park, South Australia, Australia
| | - M Costa
- College of Medicine and Public Health & Centre for Neuroscience, Flinders University, Bedford Park, South Australia, Australia
| | - D A Wattchow
- Department of Gastroenterology & Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia.,College of Medicine and Public Health & Centre for Neuroscience, Flinders University, Bedford Park, South Australia, Australia
| | - N J Spencer
- College of Medicine and Public Health & Centre for Neuroscience, Flinders University, Bedford Park, South Australia, Australia
| | - S J Brookes
- College of Medicine and Public Health & Centre for Neuroscience, Flinders University, Bedford Park, South Australia, Australia
| | - T I Omari
- Department of Gastroenterology & Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia.,College of Medicine and Public Health & Centre for Neuroscience, Flinders University, Bedford Park, South Australia, Australia
| | - P G Dinning
- Department of Gastroenterology & Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia.,College of Medicine and Public Health & Centre for Neuroscience, Flinders University, Bedford Park, South Australia, Australia
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Rosen R, Vandenplas Y, Singendonk M, Cabana M, DiLorenzo C, Gottrand F, Gupta S, Langendam M, Staiano A, Thapar N, Tipnis N, Tabbers M. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 2018; 66:516-554. [PMID: 29470322 PMCID: PMC5958910 DOI: 10.1097/mpg.0000000000001889] [Citation(s) in RCA: 515] [Impact Index Per Article: 73.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This document serves as an update of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) 2009 clinical guidelines for the diagnosis and management of gastroesophageal reflux disease (GERD) in infants and children and is intended to be applied in daily practice and as a basis for clinical trials. Eight clinical questions addressing diagnostic, therapeutic and prognostic topics were formulated. A systematic literature search was performed from October 1, 2008 (if the question was addressed by 2009 guidelines) or from inception to June 1, 2015 using Embase, MEDLINE, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Clinical Trials. The approach of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) was applied to define and prioritize outcomes. For therapeutic questions, the quality of evidence was also assessed using GRADE. Grading the quality of evidence for other questions was performed according to the Quality Assessment of Studies of Diagnostic Accuracy (QUADAS) and Quality in Prognostic Studies (QUIPS) tools. During a 3-day consensus meeting, all recommendations were discussed and finalized. In cases where no randomized controlled trials (RCT; therapeutic questions) or diagnostic accuracy studies were available to support the recommendations, expert opinion was used. The group members voted on each recommendation, using the nominal voting technique. With this approach, recommendations regarding evaluation and management of infants and children with GERD to standardize and improve quality of care were formulated. Additionally, 2 algorithms were developed, 1 for infants <12 months of age and the other for older infants and children.
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Affiliation(s)
- Rachel Rosen
- Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Children's Hospital Boston, Boston, MA
| | - Yvan Vandenplas
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Michael Cabana
- Division of General Pediatrics, University of California, San Francisco, CA
| | - Carlo DiLorenzo
- Division of Pediatric Gastroenterology, Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Frederic Gottrand
- CHU Lille, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Lille, France
| | - Sandeep Gupta
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Illinois, Peoria, IL
| | - Miranda Langendam
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples ‘‘Federico II,’’ Naples, Italy
| | - Nikhil Thapar
- Great Ormond Street Hospital for Children, London, UK
| | - Neelesh Tipnis
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS
| | - Merit Tabbers
- Emma Children's Hospital/AMC, Amsterdam, The Netherlands
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la Fuente EBD, Turcanu M, Ekberg O, Gallegos C. Rheological Aspects of Swallowing and Dysphagia: Shear and Elongational Flows. Dysphagia 2017. [DOI: 10.1007/174_2017_119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Esophageal Impedance Monitoring: Clinical Pearls and Pitfalls. Am J Gastroenterol 2016; 111:1245-56. [PMID: 27325223 DOI: 10.1038/ajg.2016.256] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 05/01/2016] [Indexed: 12/11/2022]
Abstract
The development of intraluminal esophageal impedance monitoring has improved our ability to detect and measure gastroesophageal reflux without dependence on acid content. This ability to detect previously unrecognized weak or nonacid reflux episodes has had important clinical implications in the diagnosis and management of gastroesophageal reflux disease (GERD). In addition, with the ability to assess bolus transit within the esophageal lumen, impedance monitoring has enhanced the recognition and characterization of esophageal motility disorders in patients with nonobstructive dysphagia. The assessment of the intraluminal movement of gas and liquid has also been proven to be of diagnostic value in conditions such as rumination syndrome and excessive belching. Further, alternative applications of impedance monitoring, such as the measurement of mucosal impedance, have provided novel insights into assessing esophageal mucosal integrity changes as a consequence of inflammatory change. Future applications for esophageal impedance monitoring also hold promise in esophageal conditions other than GERD. However, despite all of the clinical benefits afforded by esophageal impedance monitoring, important clinical and technical shortcomings limit its diagnostic value and must be considered when interpreting study results. Overinterpretation of studies or application of impedance monitoring in patients can have deleterious clinical implications. This review will highlight the clinical benefits and limitations of esophageal impedance monitoring and provide clinical pearls and pitfalls associated with this technology.
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Li YW, Xie CX, Wu KM, Chen MH, Xiao YL. Motility characteristics in the transition zone in Gastroesophageal Reflux Disease (GORD) patients. BMC Gastroenterol 2016; 16:106. [PMID: 27576498 PMCID: PMC5006573 DOI: 10.1186/s12876-016-0525-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/18/2016] [Indexed: 01/10/2023] Open
Abstract
Background Defects in distal oesophageal peristalsis was thought to be an indication of incomplete bolus transit (BT). However, the role of transition zone (TZ) defects in the BT in gastroesophageal reflux disease (GORD) patients needs clarification. The aim of this study was to assess the TZ defects in GORD patients and to explore the relationship between TZ defects and BT. Methods One hundred and two patients with reflux symptoms and 20 healthy adults were included in the study. All subjects underwent upper gastrointestinal endoscopy, high resolution impedance manometry (HRiM) and 24-h ambulatory multichannel impedance-pH (MII-pH) monitoring. Patients were subgrouped into reflux oesophagitis (RE), non-erosive reflux disease (NERD), hypersensitive oesophagus (HO) and functional heartburn (FH) classified following MII-pH monitoring. Oesophageal pressure topography was analysed to define TZ defects by spatial or temporal TZ measurements exceeding 2 cm or 1 s, weak and fragmented swallows were excluded, and the association between TZ and BT was investigated. Results Following liquid swallows, there were no significant differences in TZ delay time and TZ length between groups (RE: 1.75 s (1.32–2.17) and 2.50 cm (2.40–3.20); NERD: 1.60 s (1.10–2.00) and 2.20 cm (2.10–2.65); HO: 1.60 s (1.30–1.80) and 2.70 cm (2.30–3.00); FH: 1.55 s (1.20–2.17) and 3.10 cm (2.25–5.00); Healthy volunteers: 1.50 s (1.20–1.90) and 2.30 cm (2.10–3.00). However, individuals with TZ defects had lower complete BT rates compared with those without TZ defects (p < 0.001). There were also significantly more incomplete BT in patients with RE, HO and FH than in healthy controls (p < 0.05). Conclusions In GORD patients, TZ defects correlated with proximal bolus retention in the corresponding area independent of distal weak peristalsis. Electronic supplementary material The online version of this article (doi:10.1186/s12876-016-0525-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yu-Wen Li
- Department of Gastroenterology, First affiliated Hospital, Sun Yat-sen University, Guangzhou, GuangDong Province, 510080, People's Republic of China.,Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, The University of Queensland, Brisbane, QLD, 4102, Australia
| | - Chen-Xi Xie
- Department of Gastroenterology, First affiliated Hospital, Sun Yat-sen University, Guangzhou, GuangDong Province, 510080, People's Republic of China
| | - Kai-Ming Wu
- Gastrointestinal Surgery Center, First affiliated Hospital, Sun Yat-sen University, Guangzhou, GuangDong Province, 510080, People's Republic of China
| | - Min-Hu Chen
- Department of Gastroenterology, First affiliated Hospital, Sun Yat-sen University, Guangzhou, GuangDong Province, 510080, People's Republic of China.
| | - Ying-Lian Xiao
- Department of Gastroenterology, First affiliated Hospital, Sun Yat-sen University, Guangzhou, GuangDong Province, 510080, People's Republic of China.
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Miles A, Clark S, Jardine M, Allen J. Esophageal Swallowing Timing Measures in Healthy Adults During Videofluoroscopy. Ann Otol Rhinol Laryngol 2016; 125:764-9. [DOI: 10.1177/0003489416653410] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objectives: Establishing the range of normal esophageal bolus transit times (ETT) is valuable when distinguishing pathology from normal variance, especially in elderly patients, and has not been documented for paste or pill. The aim of this study was to measure esophageal transit of liquid, paste, and pill during upright videofluoroscopy. Methods: One hundred eighteen healthy adults (mean age 54; range 20-98 years; SD = 21.40) with no complaints of dysphagia completed a videofluoroscopy with esophageal visualization including 20 ml liquid barium, 5 ml paste, and pill. Results: Mean ETTs were: 20 ml fluid, 10.7 seconds (SD = 13.6, median = 5.76, IQR = 4.33, range, 2.0-60.0); pill, 25.3 seconds (SD = 24.0, median = 12.70, IQR = 49.81, range, 1.0-60.0); paste, 28.6 seconds (SD = 23.31, median = 17.47, IQR = 53, range, 4.0-60.0). Age was significantly associated with increasing 20 ml fluid ETT ( P < .001) but not pill ( P = .58) or paste ETT ( P = .12). Fluid ETT over 10 seconds occurred in 10% of participants between 20 and 59 years, in comparison to 35% over 60 years ( P < .001). Conclusions: These normative values provide a standardized protocol and guidance in interpretation when completing esophageal visualization as part of videofluoroscopy. While measuring fluid ETT may support referral for further specialist investigations, slower paste and pill ETT may be normal findings. Age-related slowing in fluid ETT was seen in healthy adults. Further investigation of ETT is needed in both normal and dysphagic subjects.
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Affiliation(s)
- Anna Miles
- Speech Science, University of Auckland, New Zealand
| | - Stacie Clark
- Speech Science, University of Auckland, New Zealand
| | | | - Jacqui Allen
- Speech Science, University of Auckland, New Zealand
- Department of Otorhinolaryngology, Northshore Hospital, Takapuna, Auckland, New Zealand
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Cresi F, Liguori SA, Maggiora E, Locatelli E, Indrio F, Bertino E, Coscia A. Esophageal Bolus Transit in Newborns with Gastroesophageal Reflux Disease Symptoms: A Multichannel Intraluminal Impedance Study. Pediatr Gastroenterol Hepatol Nutr 2015; 18:238-45. [PMID: 26770898 PMCID: PMC4712536 DOI: 10.5223/pghn.2015.18.4.238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/14/2015] [Accepted: 09/18/2015] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate bolus transit during esophageal swallow (ES) and gastroesophageal reflux (GER) events and to investigate the relationship between the characteristics of ES and GER events in a population of term and preterm newborns with symptoms of gastroesophageal reflux disease (GERD). METHODS The study population consisted of term and preterm newborns referred to combined multichannel intraluminal impedance (MII) and pH monitoring for GERD symptoms. The frequency and characteristics of ES and GER events were assessed by two independent investigators. Statistical significance was set at p<0.05. RESULTS Fifty-four newborns (23 preterm) were included in the analyses. Median bolus head advancing time corrected for esophageal length (BHATc) was shorter during mealtime than during the postprandial period (median, interquartile range): 0.20 (0.15-0.29) s/cm vs. 0.47 (0.39-0.64) s/cm, p<0.001. Median bolus presence time (BPT) was prolonged during mealtime: 4.71(3.49-6.27) s vs. 2.66 (1.82-3.73) s, p<0.001. Higher BHATc (p=0.03) and prolonged BPT (p<0.001) were observed in preterm newborns during the postprandial period. A significant positive correlation between BHATc and bolus clearance time was also observed (ρ=0.33, p=0.016). CONCLUSION The analysis of ES and GER events at the same time by MII provides useful information to better understand the physiopathology of GERD. In particular, the analysis of BHATc during the postprandial period could help clinicians identify newborns with prolonged esophageal clearance time due to impaired esophageal motility, which could allow for more accurate recommendations regarding further tests and treatment.
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Affiliation(s)
- Francesco Cresi
- Neonatal Intensive Care Unit, S.Anna-Regina Margherita Children's Hospital, Torino, Italy.; Department of Pediatrics, University of Torino, Torino, Italy
| | | | - Elena Maggiora
- Neonatal Intensive Care Unit, S.Anna-Regina Margherita Children's Hospital, Torino, Italy.; Department of Pediatrics, University of Torino, Torino, Italy
| | - Emanuela Locatelli
- Neonatal Intensive Care Unit, S.Anna-Regina Margherita Children's Hospital, Torino, Italy.; Department of Pediatrics, University of Torino, Torino, Italy
| | - Flavia Indrio
- Department of Pediatrics, University of Bari Policlinico, Bari, Italy
| | - Enrico Bertino
- Neonatal Intensive Care Unit, S.Anna-Regina Margherita Children's Hospital, Torino, Italy.; Department of Pediatrics, University of Torino, Torino, Italy
| | - Alessandra Coscia
- Neonatal Intensive Care Unit, S.Anna-Regina Margherita Children's Hospital, Torino, Italy.; Department of Pediatrics, University of Torino, Torino, Italy
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Sohn KC, Jeong YH, Jo DH, Heo WG, Yeom DH, Choi SC, Ryu HS. A Case of Aerophagia Diagnosed by Multichannel Intraluminal Impedance Monitoring. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2015; 66:282-5. [PMID: 26586352 DOI: 10.4166/kjg.2015.66.5.282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Aerophagia is a disorder caused by abnormal accumulation of air in the gastrointestinal tract as a result of repetitive and frequent inflow of air through the mouth. For the diagnosis of this condition, it is difficult to objectively measure the air swallowing. However, multichannel intraluminal impedance monitoring facilitates the differential diagnosis between normal air swallowing and pathologic aerophagia, and can aid in the determination of the frequency and amount of air swallowed. In this report, in addition to a literature review, we describe a case of 36-year-old man with abdominal distension who was diagnosed with aerophagia using esophageal impedance monitoring and was treated with clonazepam.
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Affiliation(s)
- Ki Chang Sohn
- Division of Gastroenterology, Department of Internal Medicine, Digestive Disease Research Institute, Wonkwang University College of Medicine, Iksan, Korea
| | - Young Hoon Jeong
- Division of Gastroenterology, Department of Internal Medicine, Digestive Disease Research Institute, Wonkwang University College of Medicine, Iksan, Korea
| | - Dong Ho Jo
- Division of Gastroenterology, Department of Internal Medicine, Digestive Disease Research Institute, Wonkwang University College of Medicine, Iksan, Korea
| | - Won Gak Heo
- Division of Gastroenterology, Department of Internal Medicine, Digestive Disease Research Institute, Wonkwang University College of Medicine, Iksan, Korea
| | - Dong Han Yeom
- Division of Gastroenterology, Department of Internal Medicine, Digestive Disease Research Institute, Wonkwang University College of Medicine, Iksan, Korea
| | - Suck Chei Choi
- Division of Gastroenterology, Department of Internal Medicine, Digestive Disease Research Institute, Wonkwang University College of Medicine, Iksan, Korea
| | - Han Seung Ryu
- Division of Gastroenterology, Department of Internal Medicine, Digestive Disease Research Institute, Wonkwang University College of Medicine, Iksan, Korea
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Bogte A, Bredenoord AJ, Oors J, Siersema PD, Smout AJPM. Assessment of bolus transit with intraluminal impedance measurement in patients with esophageal motility disorders. Neurogastroenterol Motil 2015; 27:1446-52. [PMID: 26284688 DOI: 10.1111/nmo.12642] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 06/23/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND The clinical management of patients with non-obstructive dysphagia is notoriously difficult. Esophageal impedance measurement can be used to measure esophageal bolus transit without the use of radiation exposure to patients. However, validation of measurement of bolus transit with impedance monitoring has only been performed in healthy subjects with normal motility and not in patients with dysphagia and esophageal motility disorders. The aim was, therefore, to investigate the relationship between transit of swallowed liquid boluses in healthy controls and in patients with dysphagia. METHODS Twenty healthy volunteers and 20 patients with dysphagia underwent concurrent impedance measurement and videofluoroscopy. Each subject swallowed five liquid barium boluses. The ability of detecting complete or incomplete bolus transit by means of impedance measurement was assessed, using radiographic bolus transit as the gold standard. KEY RESULTS Impedance monitoring recognized stasis and transit in 80.5% of the events correctly, with 83.9% of bolus transit being recognized and 77.2% of stasis being recognized correctly. In controls 79.8% of all swallows were scored correctly, whereas in patients 81.3% of all swallows were scored correctly. Depending on the contractility pattern, between 77.0% and 94.3% of the swallows were scored correctly. CONCLUSIONS & INFERENCES Impedance measurement can be used to assess bolus clearance patterns in healthy subjects, but can also be used to reliably assess bolus transit in patients with dysphagia and motility disorders.
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Affiliation(s)
- A Bogte
- Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands
| | - A J Bredenoord
- Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
| | - J Oors
- Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
| | - P D Siersema
- Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands
| | - A J P M Smout
- Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
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Krieger-Grübel C, Tutuian R, Borovicka J. Correlation of esophageal clearance and dysphagia symptom assessment after treatment for achalasia. United European Gastroenterol J 2015; 4:55-61. [PMID: 26966523 DOI: 10.1177/2050640615584732] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/01/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Early relapse after treatment of achalasia occurs in 10-32 % of patients. The best method to follow up these patients is not known. Symptoms often do not correlate with esophageal clearance: some patients are oligosymptomatic despite persistent esophageal stasis/dilatation. AIM The aim was to compare two methods of measurement of esophageal clearance (impedance manometry with barium swallow) in achalasia patients following treatment. Symptom assessment (Eckardt score/detailed dysphagia questions) was correlated with objective measurements of esophageal stasis (barium swallow and impedance manometry) in achalasia patients following treatment. METHODS Post-treatment patients were followed up after median 38.4 months (median range 1-144 months). Symptoms were quantified using the Eckardt score and detailed dysphagia questions. Timed barium swallow quantified distal esophageal retention 0.5, 1, 3, and 5 minutes after oral contrast and impedance manometry assessed total and segmental esophageal clearance during water/viscous swallows and free drinking (200 mL). RESULTS Thirty-two patients (7 women, age 48.3; range 20-74) completed all investigations. Bolus retention in the distal esophagus assessed by impedance correlated well with barium swallow. There were no differences in impedance and timed barium swallow parameters between patients with Eckardt score 0-2 points or ≥3 points. Nine (28%) patients had an Eckardt score ≥3 points and 21 (66%) had ≥1 point in the detailed dysphagia questions. Patients without any dysphagia history had lower barium column height and width at 3 and 5 minutes compared to those with ≥1 positive answer in the detailed dysphagia questions. Correlation between the Eckardt score and detailed dysphagia questions was moderately good (r = 0.546; p = 0.001). CONCLUSION A detailed history of esophageal dysphagia rather than the Eckardt score is more sensitive to detect oligosymptomatic patients with disturbed esophageal clearance. Impedance manometry correlates well with the timed-barium swallow examination and represents an alternative objective assessment as it avoids radiation exposure.
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Affiliation(s)
- Claudia Krieger-Grübel
- Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Radu Tutuian
- Division of Gastroenterology, Bern University Hospital, Berne, Switzerland
| | - Jan Borovicka
- Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Omari T, Tack J, Rommel N. Impedance as an adjunct to manometric testing to investigate symptoms of dysphagia: What it has failed to do and what it may tell us in the future. United European Gastroenterol J 2014; 2:355-66. [PMID: 25360313 DOI: 10.1177/2050640614549096] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 07/31/2014] [Indexed: 12/17/2022] Open
Abstract
Dysphagia is a common reason for referral for investigations of oesophageal motility. Impedance measurement has now been incorporated into commercially available diagnostic manometry systems for more than a decade. This innovation, which offered the ability to record patterns of bolus transport without the need for simultaneous radiology, has for the most part failed to live up to expectations, offering few additional diagnostic insights. This review examines the potential pitfalls related to how impedance patterns are currently analysed and introduces and discusses the new concept of pressure-flow analysis integrating pressure and impedance measurements to derive new metrics linked to the pressures occurring within and around the bolus as it is being transported.
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Affiliation(s)
- T Omari
- School of Medicine, Flinders University, Bedford Park, Australia ; The Robinson Institute, University of Adelaide, Adelaide, Australia ; Translational Research Center for Gastrointestinal Diseases, University of Leuven, Belgium
| | - J Tack
- Translational Research Center for Gastrointestinal Diseases, University of Leuven, Belgium
| | - N Rommel
- Translational Research Center for Gastrointestinal Diseases, University of Leuven, Belgium ; Neurosciences, ExpORL, University of Leuven, Belgium
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26
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Park EJ, Lee JS, Lee TH, Bok GH, Hong SJ, Kim HG, Jeon SR, Kim JO. High-resolution Impedance Manometry Criteria in the Sitting Position Indicative of Incomplete Bolus Clearance. J Neurogastroenterol Motil 2014; 20:491-6. [PMID: 25273119 PMCID: PMC4204409 DOI: 10.5056/jnm14012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/02/2014] [Accepted: 05/22/2014] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND/AIMS We used high-resolution impedance manometry (HRIM) to determine the length of breaks on the isobaric contour which would predict incomplete bolus clearance in patients in the sitting position. METHODS In total, 651 swallows in 71 patients with esophageal symptoms were studied using a solid-state HRIM system in the sitting position. Each swallow was classified as complete or incomplete bolus clearance by impedance criteria and peristaltic integrity was evaluated using 20- and 30-mmHg pressure topography isobaric contours. Correlations between the lengths of the breaks for 20- and 30-mmHg were analyzed. RESULTS Complete bolus clearance was observed in 83.3% (542/651) of swallows. Breaks of 3 and 7 cm or less were associated with a bolus clearance of 96.8% on the 20-mmHg and 94.7% on the 30-mmHg isobaric contour, respectively (P < 0.001). The areas under the ROC curves for the 20 and 30 mmHg isobaric contours were 0.900 and 0.950, respectively. The sensitivity and specificity for complete bolus clearance were 75.6% and 89.3% for breaks 3 cm or less on the 20-mmHg isobaric contour and 87.9% and 78.7% for breaks 7 cm or less on the 30-mmHg contour (P < 0.001). CONCLUSIONS Breaks of < 3 cm in the 20-mmHg isobaric contour or < 7 cm in the 30-mmHg isobaric contour were associated with com-plete bolus clearance. The threshold for breaks in the sitting position was greater than previous reports using the supine posi-tion and longer breaks predicted incomplete bolus clearance.(J Neurogastroenterol Motil 2014;20:491-496).
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Affiliation(s)
- Eui Ju Park
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Joon Seong Lee
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Tae Hee Lee
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Gene Hyun Bok
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Su Jin Hong
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hyun Gun Kim
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seong Ran Jeon
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jin-Oh Kim
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
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Abstract
The function of the esophagus is transporting nutrients from the oropharyngeal cavity to the stomach. This is achieved by coordinated contractions and relaxation of the tubular esophagus and the upper and lower esophageal sphincter. Multichannel intraluminal impedance monitoring offers quantification of esophageal bolus transit and/or retention without the use of ionizing radiation. Combined with conventional or high-resolution manometry, impedance measurements complement the quantification of esophageal body contraction and sphincter relaxation, offering a more comprehensive evaluation of esophageal function. Further studies evaluating the utility of quantifying bolus transit will help clarify the role and position of impedance measurements.
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Affiliation(s)
- Radu Tutuian
- Division of Gastroenterology, University Clinics of Visceral Surgery and Medicine, Bern University Hospital - Inselspital Bern, Freiburgstrasse 4, Bern 3010, Switzerland; Division of Gastroenterology, Spital Region Oberaargau (SRO) - Langenthal, St. Urbanstrasse 67, Langenthal 4900, Switzerland.
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28
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Lin Z, Imam H, Nicodème F, Carlson DA, Lin CY, Yim B, Kahrilas PJ, Pandolfino JE. Flow time through esophagogastric junction derived during high-resolution impedance-manometry studies: a novel parameter for assessing esophageal bolus transit. Am J Physiol Gastrointest Liver Physiol 2014; 307:G158-63. [PMID: 24852565 PMCID: PMC4101677 DOI: 10.1152/ajpgi.00119.2014] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This study aimed to develop and validate a method to measure bolus flow time (BFT) through the esophagogastric junction (EGJ) using a high-resolution impedance-manometry (HRIM) sleeve. Ten healthy subjects were studied with concurrent HRIM and videofluoroscopy; another 15 controls were studied with HRIM alone. HRIM studies were performed using a 4.2-mm-outer diameter assembly with 36 pressure sensors at 1-cm intervals and 18 impedance segments at 2-cm intervals (Given Imaging, Los Angeles, CA). HRIM and fluoroscopic data from four barium swallows, two in the supine and two in the upright position, were analyzed to create a customized MATLAB program to calculate BFT using a HRIM sleeve comprising three sensors positioned at the crural diaphragm. Bolus transit through the EGJ measured during blinded review of fluoroscopy was almost identical to BFT calculated with the HRIM sleeve, with the nadir impedance deflection point used as the signature of bolus presence. Good correlation existed between videofluoroscopy for measurement of upper sphincter relaxation to beginning of flow [R = 0.97, P < 0.001 (supine) and R = 0.77, P < 0.01 (upright)] and time to end of flow [R = 0.95, P < 0.001 (supine) and R = 0.82, P < 0.01 (upright)]. The medians and interquartile ranges (IQR) of flow time though the EGJ in 15 healthy subjects calculated using the virtual sleeve were 3.5 s (IQR 2.3-3.9 s) in the supine position and 3.2 s (IQR 2.3-3.6 s) in the upright position. BFT is a new metric that provides important information about bolus transit through the EGJ. An assessment of BFT will determine when the EGJ is open and will also provide a useful method to accurately assess trans-EGJ pressure gradients during flow.
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Affiliation(s)
- Zhiyue Lin
- 1Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
| | - Hala Imam
- 3Gastroenterology and Hepatology Unit, Department of Internal Medicine, Assiut University Hospital, Assiut, Egypt
| | - Frèdèric Nicodème
- 2Department of Thoracic Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; and
| | - Dustin A. Carlson
- 1Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
| | - Chen-Yuan Lin
- 1Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
| | - Brandon Yim
- 1Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
| | - Peter J. Kahrilas
- 1Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
| | - John E. Pandolfino
- 1Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
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Lin Z, Nicodème F, Lin CY, Mogni B, Friesen L, Kahrilas PJ, Pandolfino JE. Parameters for quantifying bolus retention with high-resolution impedance manometry. Neurogastroenterol Motil 2014; 26:929-36. [PMID: 24750336 PMCID: PMC4120956 DOI: 10.1111/nmo.12346] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 03/17/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study aimed to develop a methodology for quantifying esophageal bolus retention using a high-resolution esophageal impedance topography (EIT) technique. METHODS The ability of impedance to quantify bolus retention was validated by comparison with concurrent fluoroscopic imaging (barium bolus) in 10 healthy subjects. High-resolution impedance manometry (HRIM) studies without fluoroscopy were performed in another 15 healthy subjects to define normal values using saline. HRIM data from each subject were analyzed using a MATLAB program customized for calculating the esophageal impedance integral (EII) prior to the contraction wave front as EII1 and after the contraction as EII2, and presented as a ratio of EII2/EII1, which was compared to the percent of barium areas retained in the esophagus on fluoroscopy determined by a blinded reviewer. KEY RESULTS In 93% (37/40) of barium swallows, the results from the EIT method were in agreement with fluoroscopy results with one of three patterns: (1) 25 normal bolus transit, (2) eight bolus stasis, and (3) four retrograde escape or reflux. Three swallows (8%) had slight retention identified by EIT, but no retention detected by fluoroscopy. The correlation between percent of bolus retained in the esophagus detected by fluoroscopy and percent of bolus retention (EII2/EII1) after swallows with EIT method was r = 0.96 (p < 0.001) in supine and r = 0.69 (p < 0.001) in upright position. CONCLUSIONS & INFERENCES The EII ratio (EII2/EII1) is a surrogate for the fraction of retained bolus after a swallow and this metric may be useful in better defining esophageal function.
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Affiliation(s)
- Zhiyue Lin
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, U.S.A
| | - Frederic Nicodème
- Department of Thoracic Surgery, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Chen-Yuan Lin
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, U.S.A
| | - Benjamin Mogni
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, U.S.A
| | - Laurel Friesen
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, U.S.A
| | - Peter J Kahrilas
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, U.S.A
| | - John E Pandolfino
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, U.S.A
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30
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Shin GH, Sankineni A, Parkman HP. Bolus retention in hiatal hernia identified by high-resolution esophageal manometry with impedance. Neurogastroenterol Motil 2014; 26:679-84. [PMID: 24460884 DOI: 10.1111/nmo.12312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Accepted: 01/06/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Esophageal acid retention in a hiatal hernia (HH) may play a role in gastro-esophageal reflux. The aims of this study were to determine the prevalence of bolus retention (BR) in HH and to compare pressure profiles in patients with HH with BR in the hernia to those with bolus clearance (BC) through the hernia using high-resolution esophageal manometry with impedance (HREMI). METHODS Clinical HREMI studies with HH ≥1.5 cm were analyzed for lower esophageal sphincter (LES) and crural diaphragm (CD) pressures and pressure profiles during 12 saline swallows. Impedance was analyzed for swallow retention in the HH. KEY RESULTS Bolus retention in a HH was present in 35 of 53 (66%) patients with a HH. Patients with BR had overall lower pressure profiles including a lower basal LES pressure (14.8 ± 10.6 vs 28.9 ± 16.8 mmHg; p = 0.0001), LES-CD gradient (6.8 ± 17.9 vs 20.6 ± 12.2 mmHg; p = 0.002), residual LES pressure (2.5 ± 4.6 vs 6.1 ± 12.2 mmHg; p = 0.017), amplitude of distal esophageal contractions (83.2 ± 38.8 vs 111.2 ± 42.8 mmHg; p = 0.020), and distal contractile integral (1487 ± 1016 vs 2608 ± 1221 mmHg-cm-sec; p = 0.001) compared to the BC group. Patients with BR were more likely to have a larger sized HH compared to the BC group (3.1 ± 1.6 vs 2.1 ± 0.6 cm; p = 0.016); similar pressure changes were found when the groups were divided up by HH sizes. CONCLUSIONS & INFERENCES Bolus retention was seen in 66% of patients with HH. Bolus retention in the HH was associated with larger HH size, lower LES pressure, and lower esophageal contractile pressures compared to those with BC.
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Affiliation(s)
- G H Shin
- GI Section, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA
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31
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Gyawali CP, Bredenoord AJ, Conklin JL, Fox M, Pandolfino JE, Peters JH, Roman S, Staiano A, Vaezi MF. Evaluation of esophageal motor function in clinical practice. Neurogastroenterol Motil 2013; 25:99-133. [PMID: 23336590 DOI: 10.1111/nmo.12071] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Esophageal motor function is highly coordinated between central and enteric nervous systems and the esophageal musculature, which consists of proximal skeletal and distal smooth muscle in three functional regions, the upper and lower esophageal sphincters, and the esophageal body. While upper endoscopy is useful in evaluating for structural disorders of the esophagus, barium esophagography, radionuclide transit studies, and esophageal intraluminal impedance evaluate esophageal transit and partially assess motor function. However, esophageal manometry is the test of choice for the evaluation of esophageal motor function. In recent years, high-resolution manometry (HRM) has streamlined the process of acquisition and display of esophageal pressure data, while uncovering hitherto unrecognized esophageal physiologic mechanisms and pathophysiologic patterns. New algorithms have been devised for analysis and reporting of esophageal pressure topography from HRM. The clinical value of HRM extends to the pediatric population, and complements preoperative evaluation prior to foregut surgery. Provocative maneuvers during HRM may add to the assessment of esophageal motor function. The addition of impedance to HRM provides bolus transit data, but impact on clinical management remains unclear. Emerging techniques such as 3-D HRM and impedance planimetry show promise in the assessment of esophageal sphincter function and esophageal biomechanics.
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Affiliation(s)
- C P Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, USA.
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Pollard RE. Imaging evaluation of dogs and cats with Dysphagia. ISRN VETERINARY SCIENCE 2012; 2012:238505. [PMID: 23762579 PMCID: PMC3671744 DOI: 10.5402/2012/238505] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 09/19/2012] [Indexed: 01/20/2023]
Abstract
The current literature is reviewed in this paper regarding the application of diagnostic imaging in the evaluation of swallowing disorders of the dog. The applications of radiography, contrast radiography, and contrast videofluoroscopy are discussed with pertinent case examples provided for emphasis. The indications for image-guided interventions are also described.
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Affiliation(s)
- Rachel E Pollard
- Department of Surgical and Radiological Sciences, Davis School of Veterinary Medicine, The University of California, Davis, CA 95616, USA
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Bogte A, Bredenoord AJ, Oors J, Siersema PD, Smout AJPM. Relationship between esophageal contraction patterns and clearance of swallowed liquid and solid boluses in healthy controls and patients with dysphagia. Neurogastroenterol Motil 2012; 24:e364-72. [PMID: 22672410 DOI: 10.1111/j.1365-2982.2012.01949.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Non-obstructive dysphagia patients prove to be a difficult category for clinical management. Esophageal high-resolution manometry (HRM) is a novel method, used to analyze dysphagia. However, it is not yet clear how findings on HRM relate to bolus transport through the esophagus. METHODS Twenty healthy volunteers and 20 patients with dysphagia underwent HRM and videofluoroscopy in a supine position. Each subject swallowed five liquid and five solid barium boluses. Esophageal contraction parameters and bolus transport were evaluated with HRM and concurrent videofluoroscopy. KEY RESULTS Stasis of liquid and solid barium boluses occurred in patients and in healthy volunteers in 64% and 41% and in 84% and 82% of the swallows, respectively. Overall, 70% of the liquid and 72% of the solid bolus swallows were followed by a peristaltic contraction, the difference not being statistically significant. Statistically significant associations were found for transition zone length of liquid and solid boluses, and for DCI and distal contraction amplitudes for liquid stasis. No correlation was found between the degree of stasis and other manometric parameters. CONCLUSIONS & INFERENCES Stasis of both liquid and solid boluses occurs frequently in patients and in controls and can be regarded as physiological. Motility patterns can predict the effectiveness of bolus transit and level of stasis to some degree but the relationship between esophageal motility and transit is complex and far from perfect. Esophageal manometry is therefore currently deemed unfit to be used for the prediction of bolus transit, and should rather be used for the identification of treatable esophageal motility disorders.
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Affiliation(s)
- A Bogte
- Gastrointestinal Research Unit, Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands.
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34
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Abstract
Dysphagia is common in the general population, and is generally due to either mechanical obstruction or dysmotility. Patient demographics and symptom evaluation are often useful in determining the likely cause, and guide subsequent investigation and management. Oropharyngeal dysphagia is usually caused by neurological conditions where treatment options are limited. Conversely, many of the esophageal causes of dysphagia are amenable to therapy. Gastroscopy is often the first test of choice, given its diagnostic and therapeutic potential, especially when mechanical causes are concerned. Esophageal motor function can be assessed by a variety of techniques, ranging from radiology such as barium swallow, to dedicated motility tests such as manometry and impedance monitoring. The choice of test relies on the clinical indication and the results should be interpreted in conjunction with the patients' symptoms. High-resolution manometry with topography is now the new benchmark for motility studies. Several new techniques for motility testing have also become available, such as esophageal ultrasound and functional lumen imaging probe, but are currently limited to the research setting.
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Affiliation(s)
- Paul Kuo
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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35
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Analysis of intersegmental trough and proximal latency of smooth muscle contraction using high-resolution esophageal manometry. J Clin Gastroenterol 2012; 46:375-81. [PMID: 22240866 DOI: 10.1097/mcg.0b013e31823d3403] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Intersegmental troughs (ISTs) between striated and smooth muscle contraction segments on high-resolution manometry (HRM) have been linked to hypomotility disorders. We investigated the relationship between ISTs, latency of initiation of smooth muscle contraction, and motor patterns in symptomatic patients and normal controls. METHODS HRM Clouse plots were analyzed in 199 participants (47.2±1.2 y, 112F/87M), categorized into 110 participants with gastroesophageal reflux disease (GERD), 74 symptomatic participants without GERD, and 15 healthy controls. IST length was measured in centimeters and percentage esophageal length, designated extended when ≥20% esophageal length on >30% swallows. Proximal latency was measured as the time interval between onset of skeletal and smooth muscle contraction segments, and designated prolonged when ≥4s in ≥50% of swallows. RESULTS ISTs of any length were noted in 74.6% swallows and in 92.5% of participants, with a similar frequency across the 3 groups. ISTs and proximal latency were both longer in the GERD group, especially when Barrett esophagus was present, compared with non-GERD patients or controls (P≤0.03 across groups); extended IST and prolonged proximal latency followed similar trends. On multivariate logistic regression, extended IST predicted GERD [odds ratio (OR), 2.30; 95% confidence intervals (CI) 1.18-4.47], as did lower esophageal sphincter pressure <5 mm Hg (OR, 3.79-3.96; 95% CI 1.77-8.49), after controlling for age and sex; prolonged proximal latency predicted both GERD (OR, 2.03; 95% CI 1.01-4.12) and Barrett esophagus (OR 1.91, 95% CI 1.24-2.94). CONCLUSIONS Measurement of IST and proximal latency add value to HRM analysis, and may be markers of esophageal hypomotility.
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Abstract
We examined the value of impedance monitoring in measuring bolus volume compared with videoesophagram. Eighty consecutive subjects were studied with simultaneous impedance-manometry-videoesophagram. A catheter with both an impedance electrode pair and a pressure transducer at four sites (5, 10, 15, 20 cm above lower esophageal sphincter) was passed per nares. Six 10-cc boluses of 45% barium mixed with 0.9% NaCl were swallowed at 20- to 30-second intervals. When impedance fell to below 1000 ohms, other than that occurring during administered swallows, the videofluoroscopic image corresponding to the time of impedance nadir was reviewed. If barium was present at the impedance site, barium area was calculated. The video was reviewed for the cause of abnormal barium transit causing barium presence. We found 38/80 subjects had a total of 169 impedance falls to below 1000 ohms. Ninety-seven percent (164/169) of impedance falls had barium present at the impedance site, and there was good correlation (r = 0.83, P < 0.001) between impedance nadir value and barium area. The impedance nadir value : barium area relationship was similar for the three causes of barium presence identified by video: failed bolus clearing; gastroesophageal reflux; and esophageal escape. Impedance nadir values 700-999 ohms usually had a small barium area. In contrast, nadir values <400 ohms had a large barium area covering all or most of the catheter and filling the esophagus at the impedance site. Impedance falls from >1000 ohms to a low nadir value from all forms of abnormal esophageal bolus transit imply a large bolus amount.
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Affiliation(s)
- H Imam
- Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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Cho YK, Choi MG, Oh SN, Baik CN, Park JM, Lee IS, Kim SW, Choi KY, Chung IS. Comparison of bolus transit patterns identified by esophageal impedance to barium esophagram in patients with dysphagia. Dis Esophagus 2012; 25:17-25. [PMID: 21668570 DOI: 10.1111/j.1442-2050.2011.01212.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Bolus transit through the esophagus has not been validated by videoesophagram in patients with dysphagia and changes in impedance with abnormal barium transit have not been described in those patients. The aim of this study was to compare esophageal impedance findings with barium esophagram measurements in patients with dysphagia. The consecutive patients with dysphagia underwent conventional multichannel esophageal impedance manometry, after which a barium videoesophagram was performed simultaneously with multichannel esophageal impedance manometry using a mean of three swallows of barium. Esophageal emptying patterns shown in the esophagogram were classified by the degree of intraesophageal stasis and presence of intraesophageal reflux. Bolus transit patterns in impedance were classified as complete and incomplete transit. Sixteen patients (M : F = 8 : 8, mean age, 47 years) were enrolled. Their manometric diagnosis were normal (n= 6), ineffective esophageal motility (n= 1), diffuse esophageal spasm (DES; n= 2), and achalasia (n= 7). Sixty-three swallows were analyzed. According to impedance analysis, 21/22 swallows with normal barium emptying showed complete transit (96%) and 31/32 swallows with severe stasis showed incomplete transit (97%). Nine swallows with mild stasis showed either complete or incomplete transit patterns in impedance. Swallows with mild barium stasis and complete transit in impedance were observed in patients who had received treatment (two patients with achalasia with history of esophageal balloonplasty and a patient with DES after nifedipine administration). Impedance reflected severe stasis with retrograde barium movement and described typical bolus transit patterns in patients with achalasia and DES. In conclusion, impedance-barium esophagram concordance is high for swallows with normal esophageal emptying and for severe barium stasis in patients with dysphagia.
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Affiliation(s)
- Y K Cho
- Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
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Watson TJ. The cutting edge in esophageal physiology testing: equipment, uses, and analysis. Thorac Surg Clin 2011; 21:449-63. [PMID: 22040628 DOI: 10.1016/j.thorsurg.2011.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Advancements in foregut diagnostic technologies have led to improvements in the esophagologist's ability to accurately diagnose and classify esophageal pathophysiology and increased patient satisfaction and compliance in undergoing testing. The esophageal surgeon's ability to bring about a successful outcome is dependent on the proper application and interpretation of these diagnostic modalities. The ability to reliably and consistently differentiate foregut disorders from other potential contributors is an essential ingredient in assuring appropriate therapy and predicting success. The physician or surgeon treating esophageal disorders is well advised to keep abreast of ongoing advancements and to implement them into their diagnostic armamentarium.
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Affiliation(s)
- Thomas J Watson
- Department of Surgery, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box Surgery, Rochester, NY 14642, USA.
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Abstract
OBJECTIVES This validation study evaluates a new manometry impedance-based approach for the objective assessment of pharyngeal function relevant to postswallow bolus residue. METHODS We studied 23 adult and pediatric dysphagic patients who were all referred for a videofluoroscopy, and compared these patients with 10 adult controls. The pharyngeal phase of swallowing of semisolid boluses was recorded with manometry and impedance. Fluoroscopic evidence of postswallow bolus residue was scored. Pharyngeal pressure impedance profiles were analyzed. Computational algorithms measured peak pressure (Peak P), pressure at nadir impedance (PNadImp), time from nadir impedance to PeakP (PNadImp-PeakP), the duration of impedance drop in the distal pharynx (flow interval), upper esophaghageal sphincter (UES) relaxation interval (UES-RI), nadir UES pressure (NadUESP), UES intrabolus pressure (UES-IBP), and UES resistance. A swallow risk index (SRI) was derived by the formula: SRI=(FI × PNadImp)/(PeakP × (TNadImp-PeakP+1)) × 100. RESULTS In all, 76 patient swallows (35 with residue) and 39 control swallows (12 with residue) were analyzed. Different functional variables were found to be altered in relation to residue. In both controls and patients, flow interval was longer in relation to residue. In controls, but not patients, residue was associated with an increased PNadImp (suggestive of increased pharyngeal IBP). Controls with residue had increased UES-IBP, NadUESP, and UES resistance compared with patients with residue. Residue in patients was related to a prolonged UES-RI. The SRI was elevated in relation to residue in both controls and patients and an average SRI of 9 was optimally predictive of residue (sensitivity 75% and specificity 80%). CONCLUSIONS We present novel findings in control subjects and dysphagic patients showing that combined manometry and impedance recordings can be objectively analyzed to derive pressure-flow variables that are altered in relation to the bolus residual and can be combined to predict ineffective pharyngeal swallowing.
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Kim YJ. Weak peristalsis in esophageal pressure topography: classification and association with Dysphagia (am j gastroenterol 2011;106:349-356). J Neurogastroenterol Motil 2011; 17:197-9. [PMID: 21603001 PMCID: PMC3093016 DOI: 10.5056/jnm.2011.17.2.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 12/03/2010] [Accepted: 12/06/2010] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yu Jin Kim
- Division of Gastroenterology, Department of Internal Medicine, Myongji Hospital, Kwan Dong University College of Medicine, Goyang, Gyeonggi-do, Korea.
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Burgess NG, Wyeth JW. An audit of combined multichannel intraluminal impedance manometry in the assessment of dysphagia. J Gastroenterol Hepatol 2011; 26 Suppl 3:79-82. [PMID: 21443716 DOI: 10.1111/j.1440-1746.2011.06655.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Multichannel Intraluminal Impedance (MII) Monitoring is a method of examining oesophageal bolus transit without the need for radiation. In combination with oesophageal manometry it allows correlation of bolus transit with peristaltic activity. The clinical application of impedance manometry is still being refined. This audit looked to examine whether impedance manometry had advantages over standard manometry in assessment of patients with dysphagia. METHODS 41 patients with the presenting symptom of dysphagia were assessed by combined MII and oesophageal manometry at a Wellington Hospital between February 2008 and December 2009. Each underwent manometry and MII using standardised techniques. FINDINGS Achalasia was diagnosed in 23 patients (56.1%), Ineffective oesophageal motility (IEM) in 5 patients (12.2%), Diffuse oesophageal Spasm (DES) in 7 patients (17.1%), and Nutcracker oesophagus in 2 patients (4.9%). 4 patients had normal manometry studies (9.8%). All patients with achalasia, IEM, and DES had abnormal bolus transit. All patients with normal manometry had abnormal bolus transit. Both patients with nutcracker oesophagus had normal bolus transit. 4 patients with achalasia had undergone previous Hellers myotomy. Two of these patients (50.0%) now had normal LES relaxation pressures, but all four still had abnormal oesophageal peristalsis and abnormal bolus transit. INTERPRETATION Multichannel Intraluminal Impedance manometry has advantages over standard manometry in characterising the physiological abnormalities associated with dysphagia. Patients in this study had severe defects including achalasia where bolus transit was invariably poor meaning little further information was gained. Extension of this study to include a wider group of patients with dysphagia may yield different results.
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Affiliation(s)
- Nicholas G Burgess
- Wellington Gastroenterology Department, Wellington Hospital Riddiford St, Wellington, New Zealand.
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Roman S, Lin Z, Kwiatek MA, Pandolfino JE, Kahrilas PJ. Weak peristalsis in esophageal pressure topography: classification and association with Dysphagia. Am J Gastroenterol 2011; 106:349-56. [PMID: 20924368 PMCID: PMC3035759 DOI: 10.1038/ajg.2010.384] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Esophageal manometry is frequently used to assess for weak peristalsis. Although commonly used clinically, there are currently no validated metrics of weak peristalsis in high-resolution esophageal pressure topography (EPT). This study aimed to develop a classification of weak peristalsis in EPT based on a comparative analysis of control subjects and patients with unexplained non-obstructive dysphagia. METHODS High-resolution esophageal pressure topography (high-resolution impedance manometry) studies were carried out in 16 control subjects to verify EPT features associated with incomplete bolus transit (IBT). The technique of superimposing EPT plots in a computer simulation was used to derive normal limits of peristaltic integrity in EPT in another 75 control subjects. The occurrence of critical EPT defects was then compared between control subjects and 113 patients with non-obstructive dysphagia identified from a large clinical series. RESULTS IBT occurred with failed peristalsis or with breaks in the 20 mm Hg isobaric contour occurring at the proximal or distal pressure troughs in EPT plots. The normal range for isobaric contour breaks was 0-20% for large (>5 cm) and 0-30% for small (2-5 cm) breaks, with both occurring significantly more frequently in dysphagic patients. Failed peristalsis was not more frequent in dysphagic patients. CONCLUSIONS A classification of weak peristalsis adapted to EPT is proposed based on the occurrence of breaks in the 20 mm Hg isobaric contour wherein weak peristalsis with large breaks is defined by those occurring with >20% of swallows and weak peristalsis with small breaks defined by those occurring with >30% of swallows.
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Affiliation(s)
- Sabine Roman
- Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Zhiyue Lin
- Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Monika A. Kwiatek
- Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - John E. Pandolfino
- Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Peter J. Kahrilas
- Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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44
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Mainie I. High resolution manometry and multichannel intraluminal impedance oesophageal manometry in clinical practice. Frontline Gastroenterol 2010; 1:112-117. [PMID: 28839558 PMCID: PMC5536775 DOI: 10.1136/fg.2009.000620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2009] [Indexed: 02/04/2023] Open
Abstract
The past decade has seen new technological advances in the investigation of oesophageal motility disorders. Multichannel intraluminal impedance monitoring has been used as an adjunct to conventional manometry in the assessment of oesophageal function, independent of radiography. High resolution manometry provides additional information over conventional manometry, and its topographic analysis makes interpretation of studies easier. Both utilities in non-obstructive dysphagia have been used ultimately in research; however, more studies are addressing their clinical application.
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45
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Transient Lower Esophageal Sphincter Relaxation and Esophageal Motor Response. J Surg Res 2010; 159:714-9. [DOI: 10.1016/j.jss.2009.02.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Revised: 02/05/2009] [Accepted: 02/23/2009] [Indexed: 11/19/2022]
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46
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Dinning PG, Arkwright JW, Gregersen H, o'grady G, Scott SM. Technical advances in monitoring human motility patterns. Neurogastroenterol Motil 2010; 22:366-80. [PMID: 20377792 DOI: 10.1111/j.1365-2982.2010.01488.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abnormal motor patterns are implicated in many motility disorders. However, for many regions of the gut, our knowledge of normal and abnormal motility behaviors and mechanisms remains incomplete. There have been many recent advances in the development of techniques to increase our knowledge of gastrointestinal motility, some readily available while others remain confined to research centers. This review highlights a range of these recent developments and examines their potential to help diagnose and guide treatment for motility disorders.
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Affiliation(s)
- P G Dinning
- University of New South Wales, Department of Gastroenterology, St George Hospital, Sydney, Australia.
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47
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Esophageal clearance patterns in normal older adults as documented with videofluoroscopic esophagram. Gastroenterol Res Pract 2009; 2009:965062. [PMID: 19789713 PMCID: PMC2752658 DOI: 10.1155/2009/965062] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Revised: 05/18/2009] [Accepted: 06/28/2009] [Indexed: 12/19/2022] Open
Abstract
Normal esophageal bolus transport in asymptomatic healthy older adults has not been well defined, potentially leading to ambiguity in differentiating esophageal swallowing patterns of dysphagic and healthy individuals. This pilot study of 24 young (45-64 years) and old (65+years) men and women was designed to assess radiographic esophageal bolus movement patterns in healthy adults using videofluoroscopic recording. Healthy, asymptomatic adults underwent videofluoroscopic esophagram to evaluate for the presence of ineffective esophageal clearance, namely, intraesophageal stasis and intraesophageal reflux. Intraesophageal stasis and intraesophageal reflux were visualized radiographically in these normal subjects. Intraesophageal stasis occurred significantly more frequently with semisolid (96%) compared with liquid (16%) barium, suggesting that a variety of barium consistencies, as opposed to only the traditional fluids, would better define the spectrum of esophageal transport. Intraesophageal reflux was observed more frequently in older males than in their younger counterparts. The rates of intraesophageal stasis and intraesophageal reflux were potentially high given that successive bolus presentations were spaced 10 seconds apart. These findings suggest a need for a more comprehensive definition regarding the range of normal esophageal bolus transport to (a) prevent misdiagnosis of dysphagia and (b) to enhance generalization to functional eating, which involves solid foods in addition to liquids.
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48
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Pandolfino JE, Bulsiewicz WJ. Evaluation of esophageal motor disorders in the era of high-resolution manometry and intraluminal impedance. Curr Gastroenterol Rep 2009; 11:182-9. [PMID: 19463217 DOI: 10.1007/s11894-009-0029-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The past few years were an exciting time in the study of esophageal motor disorders because new technologies emerged to study esophageal motor function and bolus transit. Although conventional manometry was long considered the "gold standard" for defining esophageal motor disorders, many technologic improvements occurred due to advances in transducer technology, computerization, and graphic data presentation. In addition, a relatively new technology, intraluminal impedance, was incorporated into manometric modalities. The most sophisticated systems now include combined high-resolution manometry with high-resolution impedance. Although these techniques provide more detailed information about esophageal function, whether they improve our ability to diagnose and treat patients more effectively is debatable. However, more recent data support that these advances actually improve our ability to diagnose and treat esophageal motor disorders. This article provides an update on these technologies in clinical practice and how they may be helpful in the future.
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Affiliation(s)
- John E Pandolfino
- Division of Gastroenterology, Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA.
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49
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van Wijk MP, Sifrim D, Rommel N, Benninga MA, Davidson GP, Omari TI. Characterization of intraluminal impedance patterns associated with gas reflux in healthy volunteers. Neurogastroenterol Motil 2009; 21:825-e55. [PMID: 19368658 DOI: 10.1111/j.1365-2982.2009.01289.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
UNLABELLED Multichannel intraluminal impedance (MII) recording allows assessment of flow through the oesophagus and differentiation between liquid and gas contents. Existing MII criteria for recognition of gas gastro-oesophageal reflux (GOR) have not been validated during known gas GOR in humans. AIMS (i) Characterize MII patterns of known gas GOR and optimize criteria. (ii) Clarify interrelationships between magnitude of maximal impedance change, luminal diameter and electrode-mucosa contact. Ten healthy volunteers (six male, 21-37 years) were studied using an oesophageal MII-manometry catheter. After catheter placement, subjects were asked to drink 600 mL of carbonated soft drink. Recordings were made for 20 min and the protocol repeated. Reported belches confirmed manometrically (triggered by transient lower oesophageal sphincter relaxations) were included for analysis. Those episodes were compared against commonly used criteria. Another five subjects (three male, 26-52 years) underwent simultaneous MII and videofluoroscopy using the same protocol. Videofluoroscopic images were analyzed for luminal diameter and the presence of electrode-mucosa contact. All analyzed gas GOR episodes (n = 88) were associated with a pattern of impedance rise which was either retrograde (62.5%), synchronous (19.3%) or antegrade (18.2%). Depending on the exact criteria used, sensitivity ranged from 33% to 75%. A multivariate regression model including luminal diameter and the presence of electrode-mucosa contact as independent factors accounted for 53% of all variation in impedance changes. In conclusion, a significant number of gas GOR episodes does not meet criteria for their recognition. New criteria are proposed to include specific antegrade patterns of impedance rise. Luminal diameter and the extent of contact between the oesophageal mucosa and MII-electrodes influence the magnitude and patterning of impedance change.
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Affiliation(s)
- M P van Wijk
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Centre, Amsterdam, The Netherlands.
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Bonadio C, Pollard R, Dayton P, Leonard C, Marks S. Effects of Body Positioning on Swallowing and Esophageal Transit in Healthy Dogs. J Vet Intern Med 2009; 23:801-5. [DOI: 10.1111/j.1939-1676.2009.0325.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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