Bolus transit patterns in healthy subjects: a study using simultaneous impedance monitoring, videoesophagram, and esophageal manometry

Imam, Hisham; Shay, Steven S.; Ali, Aman; Baker, Mark E.

doi:10.1152/ajpgi.00372.2004

Cited by 113 publications

(88 citation statements)

References 15 publications

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“…The relevance of the LPZ has been a subject of controversy. While for some bolus retention in this zone might be accepted as physiologic others consider bolus stasis in this zone pathologic 9,10 . A study in 6 healthy volunteers using HRM and videofluoroscopy found a wider LPZ possibly to be more likely associated with bolus stasis 10 .…”

Section: Introductionmentioning

confidence: 99%

Characteristics of the Esophageal Low-Pressure Zone in Healthy Volunteers and Patients With Esophageal Symptoms: Assessment by High-Resolution Manometry

Pohl

Ribolsi

Savarino

et al. 2008

The American Journal of Gastroenterology

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BACKGROUND: Esophageal motility studies in humans have documented a low-pressure zone (LPZ) in the area of transition from striated to smooth muscle. While preliminary studies indicate that a bolus might be retained in this area, the clinical relevance of the LPZ remains unclear. AIM: To investigate a possible relationship between esophageal symptoms and the size of the esophageal LPZ. METHODS: We reviewed high-resolution manometry (HRM) data from patients with esophageal symptoms (dysphagia, chest pain, and heartburn/regurgitation) and asymptomatic volunteers. The proximal border of the LPZ was defined as the point where the amplitude of the proximal contraction wave declined below 30 mmHg, and the distal border as the point where the distal contraction wave first increased above 30 mmHg. RESULTS: The average (+/-standard error of mean [SEM]) length of the LPZ in 44 asymptomatic individuals was 5.4 +/-0.6 cm and did not differ (P= 0.222) from the LPZ in 64 patients with dysphagia (6.8 +/-0.4 cm), 34 patients with chest pain (6.4 +/-0.6 cm), and 42 patients with gastroesophageal reflux disease (GERD) symptoms (7.0 +/-0.6 cm). These results did not change when the length of the LPZ was corrected for total esophageal length. The time width of the LPZ in asymptomatic individuals (1.6 +/-0.2 s) was shorter than in patients with dysphagia and GERD symptoms (dysphagia 2.4 +/-0.2 s, GERD symptoms 2.8 +/-0.3 s). CONCLUSION: A time delay between the proximal and distal esophageal contraction waves might be a meaningful variable in GERD and dysphagia.Pohl et al. 1

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Section: Introductionmentioning

confidence: 99%

Characteristics of the Esophageal Low-Pressure Zone in Healthy Volunteers and Patients With Esophageal Symptoms: Assessment by High-Resolution Manometry

Pohl

Ribolsi

Savarino

et al. 2008

The American Journal of Gastroenterology

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“…Several studies showed strong correlation between impedance measurements and videofluoroscopy in assessing bolus transit in healthy adults. 14,21 Only one small study validated esophageal impedance method for bolus transit patterns in comparison with barium videoesophagram in 16 dysphagia patients, and still showed impedance monitoring as a valid transit test in dyspeptic patients with severe barium stasis. 22 However, studies using concurrent manometric and videofluoroscopic recording in symptomatic patients showed an excellent correlation between the findings from 2 tests.…”

Section: Discussionmentioning

confidence: 99%

High-resolution Impedance Manometry Criteria in the Sitting Position Indicative of Incomplete Bolus Clearance

Park

Lee

et al. 2014

J Neurogastroenterol Motil

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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 position and longer breaks predicted incomplete bolus clearance.

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“…Impedance parameters calculated for the evaluation of bolus transit using liquid and viscous swallows are: (1) total bolus transit time (between bolus entry at 20 cm above the LES and bolus exit at 5 cm above the LES); (2) bolus presence time (the interval between bolus entry and bolus exit at each impedance-measuring site); and (3) segmental transit times (the interval between bolus entry at a given level above the LES and bolus exit at the next most distal level) [10] . Swallows are classified as having: (1) [7] . 1 identified at one or more of the three distal impedancemeasuring sites.…”

Section: Mii: Clinical Aspectsmentioning

confidence: 99%

“…Studies using combined fluoroscopy and impedance have validated the convention that liquid bolus entry is characterized by a 50% drop in impedance at the recording site while bolus exit is characterized by a return to at least 50% of baseline [5,6] . Studies assessing the correlation between simultaneous barium videoesophagram and impedance revealed agreement in over 97% of swallows for determining normal bolus transit or retrograde escape and stasis [7] . Thus, this technique provides qualitative evidence of esophageal emptying.…”

Section: Introductionmentioning

confidence: 99%

New technologies in the gastrointestinal clinic and research: Impedance and high-resolution manometry

Pandolfino¹,

Kahrilas²

2009

WJG

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Bolus transit patterns in healthy subjects: a study using simultaneous impedance monitoring, videoesophagram, and esophageal manometry

Abstract: transit patterns in healthy subjects: a study using simultaneous impedance monitoring, videoesophagram, and esophageal manometry.

Cited by 113 publications

References 15 publications

Characteristics of the Esophageal Low-Pressure Zone in Healthy Volunteers and Patients With Esophageal Symptoms: Assessment by High-Resolution Manometry

Characteristics of the Esophageal Low-Pressure Zone in Healthy Volunteers and Patients With Esophageal Symptoms: Assessment by High-Resolution Manometry

High-resolution Impedance Manometry Criteria in the Sitting Position Indicative of Incomplete Bolus Clearance

New technologies in the gastrointestinal clinic and research: Impedance and high-resolution manometry

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