Effects of position on oesophageal function: studies using combined manometry and multichannel intraluminal impedance

Abstract

Multichannel intraluminal impedance (MII) allows assessment of intraoesophageal bolus transit. In the supine position, bolus transit is produced almost exclusively by peristaltic contractions; in the upright position, gravity also contributes to bolus transit. MII and peristaltic pressures were measured in four positions (0, 30, 60 and 90 degrees ) using ten swallows (5 cc each) of both water and viscous liquid with body position determined by random choice. Tracings were analysed for total bolus transit time: time interval between bolus entry at 20 cm above and bolus exit at 5 cm above the lower oesophageal sphincter (LOS) and contraction amplitudes at 5 and 10 cm above the LOS. Statistical comparison of mean values of all four body positions was done using anova and Bonnferoni post-test. Ten normal subjects (five females and five males, age 24-45 years) completed the study. At each body position, liquid material transited faster (P < 0.001) than viscous material. Both liquid and viscous materials transited at lower inclinations (0 and 30 degrees ) significantly slower than at higher inclinations (60 and 90 degrees ). There was an almost perfect inverse linear correlation between angle of inclination and bolus transit time for both liquid (r = -0.99) and viscous (r = -1.00) boluses (Spearman correlation r > 0.99 and P < 0.02 for both substances). Contraction amplitudes for liquid vs viscous material were not significantly different at a given degree of inclination. Mean distal oesophageal amplitude declined with increasing inclination. Combined MII-OM identifies and quantifies the effects of gravity on the dichotomy between specific pressures measured by OM and function assessed as transit measured by MII.

The effects of tegaserod on oesophageal function and bolus transport in healthy volunteers: studies using concurrent high‐resolution manometry and videofluoroscopy

“…Moving from the supine to the upright position increased oesophageal velocity and decreased contractile pressure, changes that likely reflect a reduction in workload required for bolus transport in the upright position. [24][25][26][27] There was a further increase in oesophageal velocity and decrease in contractile pressure after the meal. This may also reflect the reduced resistance to bolus transport following the fall in LOS pressure and length after a meal.…”

“…Results from the mixed model ANOVA revealed that tegaserod had no effect on median LOS pressure compared with placebo [23 (18-29) vs. 23 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) …”

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

“…Bolus entry was defined as ≥ 50% decrease in impedance with respect to baseline. [12][13][14] Bolus clearance was defined as sustained (＞ 5 seconds) ≥ 50% increase in impedance from the original baseline impedance. 15 Complete bolus clearance was defined as bolus entry followed by bolus clearance at all impedance recording sites, and incomplete bolus clearance was defined as bolus entry followed by failure of bolus clearance at any of the impedance recording sites.…”

“…In the isobaric 30-mmHg contour, the median (interquartile range) length of the break of incomplete bolus clearance was 13.5 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) cm and that of complete clearance was 3 (1-6) cm (P ＜ 0.001).…”

Uso Y Abuso Del Estudio Radiologico De Esofago, Estomago Y Duodeno en Pacientes Pediatricos: Necesidad De Una Adecuada Normativa Y De Una Estandarizacion Del Examen

“…En cuanto al método utilizado para realizar el estudio radiológico, la mayor proporción del tiempo el paciente se encuentra en decúbito supino, lo cual ha sido demostrado aumenta los episodios de RGE en exámenes de monitoreo de pH en 24 horas (23)(24) . El volumen de bario utilizado no ha sido estandarizado, pero la recomendación es utilizar una cantidad suficiente como para obtener una adecuada oferta a la unión gastroesofágica, evaluada bajo visión fluoroscópica.…”