Successful esophageal emptying depends on the generation of a sustained intrabolus pressure (IBP) sufficient to overcome esophagogastric junction (EGJ) obstruction. Our aim was to develop a manometric analysis paradigm that describes the bolus driving pressure difference and the flow permissive time for esophageal bolus transit. Twenty normal subjects were studied with a 36-channel manometry assembly (1-cm spacing) during two 5-and one 10-ml barium swallows and concurrent fluoroscopy. Bolus domain pressure plots were generated by plotting bolus domain pressure (BDP) and EGJ relaxation pressure. BDP was defined as the pressure midway between the peristaltic ramp-up and the proximal margin of the EGJ. The flow permissive time was defined as the period where the BDP was Ն EGJ relaxation pressure. The mean BDP was 11.7 Ϯ 1.0 mmHg (SE), and the mean flow permissive time was 3.9 Ϯ 0.4 s for 5-ml swallows in normal controls. The mean BDP difference during flow was 4.0 Ϯ 1.0 mmHg. There was no significant difference in the fluoroscopic transit time and the flow permissive time calculated from the BDP plots (5 ml: fluoroscopy 3.4 Ϯ 0.2 s; BDP 3.9 Ϯ 0.4 s, P Ͼ 0.05). BDP plots provide a reliable measurement of IBP and its relationship with EGJ relaxation. The time available for flow can be readily delineated from this analysis, and the driving pressure responsible for flow can be accurately described and quantified. This may help predict abnormal bolus transit and the underlying mechanical properties of the EGJ. esophageal emptying; high-resolution manometry; fluoroscopy; intraluminal pressure gradients SUCCESSFUL BOLUS TRANSIT DURING swallowing results from a delicate balance between the forces promoting esophageal clearance [peristaltic function and intrabolus pressure (IBP)] and the outflow obstruction at the esophagogastric junction (EGJ) (EGJ compliance) (10). Recent studies combining manometry and intraluminal impedance suggest that abnormal bolus transit is reliant on this delicate balance. Assessing a cohort of 350 patients with dysphagia, Tutuian et al. (11) found that subjects with abnormalities of EGJ relaxation could exhibit normal bolus transit if peristalsis was intact. This finding suggests that normal bolus transit can still occur in the context of a poorly relaxing EGJ if peristalsis can generate a sufficient IBP to overcome the EGJ obstruction pressure. Thus defining the balance between IBP and EGJ obstruction pressure could be helpful in both predicting abnormal bolus transit and defining the dominant mechanism responsible for impaired esophageal emptying.To quantify the dynamic instantaneous relationship between IBP and EGJ obstruction pressure, it is necessary to measure the intraluminal pressure environment accurately with sufficient resolution of the IBP gradients while also accounting for the dynamic orad movement of the EGJ (7). Conventional manometry with or without a sleeve sensor is not sufficient to accurately measure and resolve the dynamic simultaneous relationship between IBP and EGJ pressu...

Endoscopy plays a fundamental role in the diagnosis, management, and treatment of inflammatory bowel disease (IBD). Colonoscopy, flexible sigmoidoscopy, and esophagogastroduodenoscopy have long been used in the care of patients with IBD. As endoscopic technologies have progressed, tools such as endoscopic ultrasound, capsule endoscopy, and balloon-assisted enteroscopy have expanded the role of endoscopy in IBD. Furthermore, chromoendoscopy has enhanced our ability to detect dysplasia in IBD. In this review article, we will focus on the roles, indications, and limitations of these tools in IBD. We will also discuss the most commonly used endoscopic scoring systems, as well as special considerations in post-surgical patients. Lastly, we will discuss the role of endoscopy in the diagnosis and management of fistulae and strictures.

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BACKGROUND-Esophageal bolus clearance requires a preferential esophagogastric pressure gradient sustained for a sufficient period. We aimed to validate a high-resolution manometry (HRM) paradigm for predicting bolus clearance.