High resolution manometry to detect transient lower oesophageal sphincter relaxations: diagnostic accuracy compared with perfused‐sleeve manometry, and the definition of new detection criteria

Roman, Sabine; Zerbib, Frank; Belhocine, K.; Varannes, Stanislas Bruley des; Mion, François

doi:10.1111/j.1365-2036.2011.04728.x

Cited by 47 publications

(56 citation statements)

References 23 publications

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“…Specifically, the study aimed to identify motor dysfunctions not diagnosed by conventional manometry or radiology [12], using a series of closely spaced pressure sensors to simultaneously view the entire swallowing mechanism, with a speci c focus on LES motility [13]. is approach permits a more detailed analysis of motor function than has previously been undertaken in these individuals [12,[14][15][16]]. An additional aim was to evaluate whether changes in body position or bolus J Gastrointestin Liver Dis, September 2014 Vol.…”

mentioning

confidence: 99%

Changes in Esophageal and Lower Esophageal Sphincter Motility with Healthy Aging

Besanko

Burgstad

Cock

et al. 2014

JGLD

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Background & Aims: Swallowing difficulties become increasingly prevalent in older age. Differences exist in lower esophageal sphincter (LES) function between older and younger patients with dysphagia, but the contribution of aging per se to these is unclear.Methods: Esophageal motor function was measured using high resolution manometry in older (aged 81±1.7 yrs) and younger (23±1.7 yrs) asymptomatic healthy adults. After baseline recording, motility was assessed by swallowing boluses of liquid (right lateral and upright postures) and solids. Basal LES pressure, integrated relaxation pressure, distal esophageal peristaltic amplitude and velocity were measured. Data are presented as mean ą SEM.Results: Despite a trend for lower basal LES pressure (15.7±2.9 mmHg vs. 21.0±0.2mmHg; P=0.08),completeness of LES relaxation was reduced in older subjects (liquid RL: P=0.003; UR: P=0.007; solid: P=0.03), with higher integrated relaxation pressure when upright (liquid: 6.9±1.1 vs. 3.1±0.4 mmHg; P=0.01; solids: 8.1±1.1 vs. 3.6±0.3 mmHg; P=0.001) and a longer time to recovery after liquid boluses (right lateral: P=0.01; upright: P=0.04). In young, but not older adults, esophageal peristaltic velocity was increased when upright (3.6±0.2 cm/sec; P=0.04) and reduced with solids (3.0±0.1 cm/sec; P=0.03). Distal contraction amplitude was higher with solids in the young (51.8±7.9 mmHg) but not older (41.4±6.2 mmHg; P=0.03) individuals. In elderly subjects, the distal contractile integral was higher with liquid swallows in the upright posture (P=0.006).Conclusion: There are subtle changes in LES function even in asymptomatic older individuals. These agerelated changes may contribute to the development of dysphagia.

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mentioning

confidence: 99%

Changes in Esophageal and Lower Esophageal Sphincter Motility with Healthy Aging

Besanko

Burgstad

Cock

et al. 2014

JGLD

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“…Indeed, HRM improves characterization of LES zones and esophageal body motility, increasing diagnostic yield and accuracy [121] . Moreover, HRM must be regarded as the new gold standard for detecting TLESRs [43] . However, the value of HRM in clinical practice has yet to be established fully Exclusion of severe esophageal motility disorders (i.e., achalasia) is important because such diseases can present with heartburn and regurgitation, which could lead to an erroneous diagnosis of GERD [122] .…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, minor but they are accompanied by diaphragmatic inhibition, and they persist for longer periods than swallowinduced LES relaxations (> 10 s) [41,42] . In a recent study, Roman et al [43] demonstrated that HRM is reproducible and more sensitive than perfused-sleeve manometry to detect TLESRs, providing better interobserver agreement. Notably, in GERD patients, there is not an increased frequency of TLESR compared with controls but only a greater frequency of acid reflux during TLESRs [44] .…”

Section: High Resolution Manometrymentioning

confidence: 99%

Esophageal testing: What we have so far

Bortoli¹,

Martinucci²,

Bertani³

et al. 2016

WJGP

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Gastroesophageal reflux disease (GERD) is a common disorder of the gastrointestinal tract. In the last few decades, new technologies have evolved and have been applied to the functional study of the esophagus, allowing for the improvement of our knowledge of the pathophysiology of GERD. High-resolution manometry (HRM) permits greater understanding of the function of the esophagogastric junction and the risks associated with hiatal hernia. Moreover, HRM has been found to be more reproducible and sensitive than conventional water-perfused manometry to detect the presence of transient lower esophageal sphincter relaxation. Esophageal 24-h pH-metry with or without combined impedance is usually performed in patients with negative endoscopy and reflux symptoms who have a poor response to anti-reflux medical therapy to assess esophageal acid exposure and symptom-reflux correlations. In particular, esophageal 24-h impedance and pH monitoring can detect acid and non-acid reflux events. EndoFLIP is a recent technique poorly applied in clinical practice, although it provides a large amount of information about the esophagogastric junction. In the coming years, laryngopharyngeal symptoms could be evaluated with up and coming non-invasive or minimally invasive techniques, such as pepsin detection in saliva or pharyngeal pH-metry.

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“…Kuribayashi et al [14] reported that the Starlet with a Unisensor catheter could evaluate esophageal motility precisely. TLESRs were evaluated according to previously published criteria for HRM reported by Roman et al [15], as follows: (1) absence of swallowing for 4 s before and for 2 s after the onset of LES relaxation; (2) the 4-s integrated relaxation pressure measured within the LES relaxation was 50% or less of the basal LES pressure; (3) the presence of swallowing was allowed if the LES relaxation duration was longer than 10 s in the absence of multiple swallows; and (4) inhibition of the crural diaphragm was also taken into account (fig. 1a).…”

Section: Methodsmentioning

confidence: 99%

Novel Prokinetic Acotiamide Reduces Transient Lower Esophageal Sphincter Relaxation in Healthy Subjects

Yamashita

Kanamori²,

Fukuchi³

et al. 2015

Digestion

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Background/Aims: Currently, there is no study evaluating the effect of acotiamide on transient lower esophageal sphincter relaxations (TLESRs). The aim of this study was to evaluate the effect of acotiamide on TLESRs using simultaneous high-resolution manometry (HRM) and impedance-pH monitoring. Methods: Ten healthy subjects were enrolled. On day 1, subjects underwent HRM and impedance-pH recordings as a baseline. Subjects ate a 750-kcal liquid meal; recording was continued for 2 h while the subjects were in a sitting position. After the administration of acotiamide 100 mg three times a day for 1 week, subjects underwent HRM and impedance-pH recording under the same protocol. Results: A total of 208 TLESRs were identified at baseline. Acotiamide decreased the total number of TLESRs from 208 to 143 (p < 0.05). The rate of reflux events during TLESRs after acotiamide administration was similar to that at baseline (57% after acotiamide vs. 58% at baseline). Bolus clearance time was significantly reduced by acotiamide. Conclusions: Acotiamide was believed to have the potential for reducing TLESRs and for enhancing esophageal bolus clearance in healthy volunteers. Future research is needed to determine whether the effects of acotiamide that reduce TLESRs and enhance esophageal motility could improve symptoms in patients with refractory gastroesophageal reflux disease.

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High resolution manometry to detect transient lower oesophageal sphincter relaxations: diagnostic accuracy compared with perfused‐sleeve manometry, and the definition of new detection criteria

Abstract: High resolution manometry is reproducible and more sensitive than PSM to detect tLESRs. HRM provides a better interobserver agreement. These results confirm that HRM is the gold standard for detecting tLESRs (NTC00931593).

Cited by 47 publications

References 23 publications

Changes in Esophageal and Lower Esophageal Sphincter Motility with Healthy Aging

Changes in Esophageal and Lower Esophageal Sphincter Motility with Healthy Aging

Esophageal testing: What we have so far

Novel Prokinetic Acotiamide Reduces Transient Lower Esophageal Sphincter Relaxation in Healthy Subjects

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