Combined impedance-manometry for the evaluation of esophageal disorders

Holloway, Richard H.

doi:10.1097/mog.0000000000000079

Cited by 13 publications

(9 citation statements)

References 26 publications

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“…Nevertheless, visceral mechanosensitivity is strongly influenced by contractile activity. Hence, we used HRiM to also evaluate the impact of CRH on esophageal contractility and bolus flow (20,36). CRH administration resulted in higher DCI values, indicating increased amplitude of esophageal contractions in response to liquid, semisolid, and solid bolus swallows.…”

Section: Discussionmentioning

confidence: 99%

The effect of intravenous corticotropin-releasing hormone administration on esophageal sensitivity and motility in health

Broers

Melchior

Oudenhove

et al. 2017

American Journal of Physiology-Gastrointestinal and Liver Physi

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Esophageal hypersensitivity is important in gastroesophageal reflux disease (GERD) patients who are refractory to acid-suppressive therapy. Stress affects visceral sensitivity and exacerbates heartburn in GERD. Peripheral CRH is a key mediator of the gut stress response. We hypothesize that CRH increases esophageal sensitivity and alters esophageal motility in health. Esophageal sensitivity to thermal, mechanical, electrical, and chemical stimuli was assessed in 14 healthy subjects after administration of placebo or CRH (100 μg iv). Perception scores were assessed for first perception, pain perception threshold (PPT), and pain tolerance threshold (PTT). Esophageal motility was investigated by high-resolution impedance manometry, before and after CRH and evaluated by distal contractile integral (DCI) and intrabolus pressure (IBP). Pressure flow analysis assessed bolus clearance (impedance ratio), degree of pressurization needed to propel bolus onward (IBP slope), and pressure flow (pressure flow index, PFI). Stress and mood were assessed during the study. Sensitivity to mechanical distention was increased after CRH compared with placebo (PPT: = 0.0023; PTT: = 0.0253). CRH had no influence on the other stimulations. DCI was increased for all boluses (liquid, = 0.0012; semisolid, = 0.0017; solid, = 0.0107). Impedance ratio for liquid ( < 0.0001) and semisolid swallows ( = 0.0327) decreased after CRH. IBP slope increased after CRH for semisolid ( = 0.0041) and solid ( = 0.0003) swallows. PFI increased for semisolid ( = 0.0017) and solid swallows ( = 0.0031). CRH increased esophageal sensitivity to mechanical distention, not to the other stimulation modalities. CRH increased esophageal contractility and tone, decreased LES relaxation, increased esophageal bolus pressurization, improved esophageal bolus clearance, and increased pressure flow. This is the first study to address the effect of corticotropin-releasing hormone (CRH) on esophageal sensitivity and alterations in motility in health. CRH administration increased esophageal sensitivity to mechanical distention. This effect is accompanied by an increase in esophageal contractility and tone and a decrease in lower esophageal sphincter relaxation. CRH increased esophageal bolus pressurization, improved esophageal bolus clearance, and increased pressure flow. The changes in esophageal contractile properties may underlie the increased sensitivity to mechanical distention after CRH.

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Section: Discussionmentioning

confidence: 99%

The effect of intravenous corticotropin-releasing hormone administration on esophageal sensitivity and motility in health

Broers

Melchior

Oudenhove

et al. 2017

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…The combination of impedance and HRM (HRIM) offers a comprehensive evaluation of the esophageal function, including esophageal motility and bolus transit, and in particular, we can assess the measurement of bolus transport in relation to the esophageal pressures driving it 37,38 . This innovative technique has been shown to improve the detection of relevant motor abnormalities 39 and the recent development of automated impedance manometry (AIM) analysis, in which the impedance and pressure data are processed together to evaluate the interactions between contractions and flow has represented a further technical advance 40 …”

Section: Data From High‐resolution Impedance Manometry (Hrim) In Syst...mentioning

confidence: 99%

Towards a more precise classification of esophageal motility disorders in patients with systemic sclerosis

Marabotto

Savarino

2022

Neurogastroenterology Motil

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Systemic sclerosis (SSc) is a chronic and generalized disease affecting the connective tissue of the skin and many internal organs, in particular the gastrointestinal tract.The esophagus is involved in up to 80% of the cases and represents a major cause of serious morbidities that deeply impact on the quality of life and survival of patients.How to cite this article: Marabotto E, Savarino V, Savarino E.Towards a more precise classification of esophageal motility disorders in patients with systemic sclerosis.

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“…In addition, HRM is a very helpful method to understand distinct properties of esophageal motility; therefore, it could better characterize the mechanisms of gastroesophageal reflux disease (GERD) and abnormal esophageal body motion [ 2 ]. However, HRM cannot provide information about bolus transport whose conclusions have been based on studies combining manometry with radiological visualization of flow and clearance [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Assessment of Esophageal High-Resolution Impedance Manometry in Patients with Nonobstructive Dysphagia

Liu

Liao

Tian

et al. 2018

Gastroenterology Research and Practice

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Background High-resolution impedance manometry (HRIM) can calculate the bolus motion parameters and the ratio of complete esophageal transit besides the conventional esophageal dynamic parameters; therefore, we could better manage the patients with nonobstructive dysphagia (NOD) clinically. Aim To analyze the HRIM parameter results of NOD patients and evaluate the characteristics of their esophageal motility and transit function. Methods In total, 58 NOD patients were assessed and the clinical diagnoses were determined. HRIM was performed, and both conventional high-resolution manometry and esophageal transit parameters were analyzed. Results In 58 NOD patients, 28 patients had achalasia, 3 esophagogastric junction outflow obstruction, and 20 nonspecific esophageal motility disorders, and 7 were normal. Impedance results demonstrated that all the patients with achalasia exhibited incomplete esophageal transit (ICET), three patients with esophagogastric junction outflow obstruction showed ICET, and the average bolus transit time (BTT) was 6.6 ± 1.2 sec. In 20 nonspecific esophageal motility disorders, 13 patients with gastroenterologly reflux disease (GERD) presented ineffective esophageal motility and fragmented peristalsis, and 65.0% swallows had exhibited ICET. However, 49.1% swallows of 7 nonspecific esophageal motility disorder patients with non-GERD had exhibited ICET. The average BTT in 13 GERD patients was longer than that in the non-GERD patients (8.1 ± 1.1 sec versus 5.5 ± 0.3 sec, P < 0.05). And in the seven patients with normal esophagus function, 3.5% swallows showed ICET and BTT was 5.6 ± 0.3 sec. Conclusion Achalasia was the most common esophageal dysmotility in NOD patients, followed by nonspecific esophageal motility disorders. The clinical diagnoses of NOD were mostly achalasia and GERD. Impedance assessments showed that all achalasia cases exhibited ICET, and other esophageal motility abnormalities that represented ICET were associated with contraction break and ineffective swallow. Compared to non-GERD patients, BTT was significantly prolonged in patients with GERD.

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Combined impedance-manometry for the evaluation of esophageal disorders

Abstract: Through ongoing technical development, impedance-manometry is becoming increasingly useful clinically to assess esophageal motility disorders as well as to provide further insights into esophageal physiology.

Cited by 13 publications

References 26 publications

The effect of intravenous corticotropin-releasing hormone administration on esophageal sensitivity and motility in health

The effect of intravenous corticotropin-releasing hormone administration on esophageal sensitivity and motility in health

Towards a more precise classification of esophageal motility disorders in patients with systemic sclerosis

Assessment of Esophageal High-Resolution Impedance Manometry in Patients with Nonobstructive Dysphagia

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