Comparative effect of the sites of anterior cervical pressure on the geometry of the upper esophageal sphincter high‐pressure zone

Abstract

External cricoid pressure is increasingly used to augment the upper esophageal sphincter (UES). Objective To determine the effect of: 1) pressures applied to cricoid, supra-cricoid and sub-cricoid regions on the length and amplitude of UES high-pressure zone (UESHPZ). 2) external cricoid pressure on LES tone. Study Design case-control study. Methods We studied 11 patients with supraesophageal reflux (58 ± 12 yr) and 10 healthy volunteers (47 ± 19 yr). We tested 20, 30, 40 mmHg pressures to cricoid, 1 cm proximal and 1 cm distal to cricoid. In an additional 15 healthy volunteers (46 ± 23 yr), we studied the effect of external cricoid pressure on LES tone. UES and LES pressures were determined using high-resolution manometry. Results There was significant increase of UESHPZ length with application of pressure at all sites. The increase of UESHPZ length was relatively symmetric, more orad and more caudad when the pressure was applied at the cricoid, supra-cricoid and sub-cricoid levels, respectively. The magnitude of pressure increase was greatest at the middle and orad part of the UESHPZ when the pressure was applied at the cricoid and supra-cricoid levels, respectively. The corresponding magnitude of increase in the caudad part of the UESHPZ was not observed with pressure at sub-cricoid level. There was no change of the LES pressure with application of cricoid pressure. Conclusions Effect of external pressure on UESHPZ is site dependent. Sub-cricoid pressure has the least effect on UESHPZ. External cricoid pressure at 20–40mmHg has no effect on the LES pressure.

Effect of Topical Nasal Anesthetic on Comfort and Swallowing in High‐Resolution Impedance Manometry

“…With no set protocol for TNA administration, a pharyngeal HRM/HRIM international working group recommends judicious use of topical anesthetic until further data suggest otherwise 10 . Many studies do not systematically provide sufficient details about TNA use or omission 11–19 . There is variation in the type, amount, and method of TNA across studies 20–33 .…”

“…10 Many studies do not systematically provide sufficient details about TNA use or omission. [11][12][13][14][15][16][17][18][19] There is variation in the type, amount, and method of TNA across studies. [20][21][22][23][24][25][26][27][28][29][30][31][32][33] Topical anesthetic to the pharynx has additionally been applied together with TNA in some studies, especially with large-diameter catheters.…”

Tolerability and Feasibility of the Upper Esophageal Sphincter Assist Device in Preventing Acute and Chronic Allograft Rejection Among Lung Transplant Recipients

“…The device is fitted around the neck in order to apply 20 to 30 mm Hg pressure over the external cricoid cartilage, a location that has been manometrically verified to enhance UES competence. 6 Given that the majority of LPR events occur while supine, 7 the UESAD is primarily intended for overnight use but may also be worn after meals for the prevention of postprandial reflux. In a prospective study of patients with LPR symptoms, the UESAD was associated with significant improvements in reflux symptoms on validated questionnaires.…”

“…The upper esophageal sphincter assist device (UESAD) is a nonpharmacologic apparatus that was FDA approved in 2015 for the treatment of LPR. The device is fitted around the neck in order to apply 20 to 30 mm Hg pressure over the external cricoid cartilage, a location that has been manometrically verified to enhance UES competence 6 . Given that the majority of LPR events occur while supine, 7 the UESAD is primarily intended for overnight use but may also be worn after meals for the prevention of postprandial reflux.…”