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

Abstract

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.

Characteristics of symptomatic belching in patients with belching disorder and patients who exhibit gastroesophageal reflux disease with belching

“…The high-resolution manometry protocol included 30 seconds without swallows to assess basal esophagogastric junction pressure and morphology, followed by 10 swallows of 5 mL of 0.3% saline solution. 7 …”

The effect of position on esophageal structure and function determined with solid‐state high‐resolution manometry

“…Data has shown that head rotation and body position can affect UES, EGJ and bolus clearance. Some investigators have even recommended studying patients in the physiological upright position.…”

“…Solid-state HRM can also accurately detect the relationship between LES and CD and facilitate the visualization of the interpretation of LES relaxation. 6,12 Data has shown that head rotation and body position can affect UES, 13 EGJ 14 and bolus clearance 14 . Some investigators 15 have even recommended studying patients in the physiological upright position.…”