Modern solid state computerized manometry of the pharyngoesophageal segment

Castell, June A.; Castell, Donald O.

doi:10.1007/bf01354550

Cited by 93 publications

(72 citation statements)

References 31 publications

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“…In order for these plots to appear smooth (as opposed to notched), the dataset was enhanced both in the time dimension (between sampling times) and in the spatial dimension (between pressure recording sites). This interpolation was done using a piecewise cubic Hermite interpolation polynomial function in MATLAB implemented on a finely resolved rectilinear space-time grid to generate intermediate data points, resulting in a virtual increase in the spatial data from 1 to 10 recording sites per cm and doubling the temporal sampling rate from 35 to 70 Hz (3,9). Manometric data corresponding to the UES were isolated from the interpolated dataset using a computer program that defined the initiation of either UES relaxation or orad movement and the spatial limits of the UES highpressure zone.…”

Section: Methodsmentioning

confidence: 99%

Deglutitive upper esophageal sphincter relaxation: a study of 75 volunteer subjects using solid-state high-resolution manometry

Ghosh¹,

Pandolfino²,

Zhang³

et al. 2006

American Journal of Physiology-Gastrointestinal and Liver Physi

145

130

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. Deglutitive upper esophageal sphincter relaxation: a study of 75 volunteer subjects using solid-state high-resolution manometry. Am J Physiol Gastrointest Liver Physiol 291: G525-G531, 2006. First published April 27, 2006 doi:10.1152/ajpgi.00081.2006.-This study aimed to use a novel high-resolution manometry (HRM) system to establish normative values for deglutitive upper esophageal sphincter (UES) relaxation. Seventy-five asymptomatic controls were studied. A solid-state HRM assembly with 36 circumferential sensors spaced 1 cm apart was positioned to record from the hypopharynx to the stomach. Subjects performed ten 5-ml water swallows and one each of 1-, 10-, and 20-ml volume swallows. Pressure profiles across the UES were analyzed using customized computational algorithms that measured 1) the relaxation interval (RI), 2) the median intrabolus pressure (mIBP) during the RI, and 3) the deglutitive sphincter resistance (DSR) defined as mIBP/RI. The automated analysis succeeded in confirming bolus volume modulation of both the RI and the mIBP with the mean RI ranging from 0.32 to 0.50 s and mIBP ranging from 5.93 to 13.80 mmHg for 1-and 20-ml swallows, respectively. DSR was relatively independent of bolus volume. Peak pharyngeal contraction during the return to the resting state postswallow was almost 300 mmHg, again independent of bolus volume. We performed a detailed analysis of deglutitive UES relaxation with a novel HRM system and customized software. The enhanced spatial resolution of HRM allows for the accurate, automated assessment of UES relaxation and intrabolus pressure characteristics, in both cases confirming the volume-dependent effects and absolute values of these parameters previously demonstrated by detailed analysis of concurrent manometry/fluoroscopy data. Normative values were established to aid in future clinical and investigative studies. deglutitive sphincter resistance; relaxation interval; intrabolus pressure IT IS SOMEWHAT IRONIC that although the upper esophageal sphincter (UES) is the most accessible structure of the esophagus, it is in many ways the least well-understood. Several reflex pathways have been described linking the UES to the esophagus and pharynx (15,20,21,23,24) as have age-related changes in contractile vigor (2,7,22,25,31); however, with the exception of belch-related dysfunction (14, 15), none of these observations have yet been linked to pathological conditions. With respect to pathological conditions, the only clear dysfunction of the UES relates to alterations in its response during swallowing, specifically impaired UES opening during swallowing and impaired relaxation during swallow. Impaired opening, manifest as either stenosis with a cricopharyngeal bar or Zenker's diverticulum (5,8,26), is a recognized cause of dysphagia. Impaired relaxation is probably less common but can be related to neurological dysfunction, best characterized in the case of Parkinson's disease (1, 29). Thus, from a clinical perspective, the functional evaluation of the UES must, first an...

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Section: Methodsmentioning

confidence: 99%

Deglutitive upper esophageal sphincter relaxation: a study of 75 volunteer subjects using solid-state high-resolution manometry

Ghosh¹,

Pandolfino²,

Zhang³

et al. 2006

American Journal of Physiology-Gastrointestinal and Liver Physi

145

130

View full text Add to dashboard Cite

show abstract

“…The oral end of the UES was defined as 10 mmHg above baseline. Controversies surround the interpretation of UES pressure measurements obtained with a triple-lumen catheter [17,18]. Because the same technique was used by the same investigator on all subjects and the mean of 15 readings (5 pull-throughs for 3 orifices) per patient was used for analysis, this study was regarded as acceptable for evaluating interpatient and intergroup differences.…”

Section: Esophageal Manometrymentioning

confidence: 99%

Facioscapulohumeral Muscular Dystrophy: A Radiologic and Manometric Study of the Pharynx and Esophagus

Stübgen

2008

Dysphagia

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Facioscapulohumeral muscular dystrophy (FSHD) is not a recognized neuromuscular cause of dysphagia. However, a study of pharyngoesophageal function in FSHD has not been performed or reported. The aim of this study was to ascertain by relatively noninvasive techniques whether the dystrophic muscle disease that underlies FSHD involves the pharyngeal and/or the esophageal striated and smooth muscles. We used conventional cineradiography and intraluminal esophageal manometry on separate occasions to study pharyngeal and esophageal function in 20 patients with FSHD at various stages of disease, with or without complaints of deglutition. Age-and sexmatched control data were used for comparison of the manometric component of the study. Twelve men and eight women with FSHD were studied. The mean patient age was 38.1 years (41.9 years for controls), and the age range was 19-61 years (22-55 years for controls). The mean disease duration was 16.7 years (range = 4-39 years).Five patients admitted to having intermittent oropharyngeal dysphagia (difficulty to initiate swallowing, cough after swallowing, sensation of food stuck in throat, or nasal regurgitation), and three patients admitted to intermittent esophageal dysphagia (difficulty swallowing both liquids and solids). Chest roentgengrams showed a hiatal hernia in four patients, but no active cardiopulmonary disease. Abnormal instrumental results were documented in eight patients: Cineradiography detected ineffectual pharyngeal contractions (2 patients), pharyngeal diverticula but normal pharyngeal motility (2 patients), and decreased cricopharyngeal and upper esophageal relaxation (2 patients). The mean manometric pressure of the patient group was not significantly different from the control data. However, manometry detected motility abnormalities that were not reflected in the mean data and included increased lower esophageal sphincter

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“…The oral end of the UES was defined as 10 mmHg above baseline. Controversies surround the interpretation of UES pressure measurements obtained with a triple-lumen catheter [21,22]. Because the identical technique was used by the same investigator on all subjects, and the mean of 15 readings (5 pull-throughs for each of 3 orifices) per patient was used for analysis, this study was regarded acceptable to evaluate interpatient and intergroup differences.…”

Section: Esophageal Manometrymentioning

confidence: 99%

Rigid Spine Syndrome: A Radiologic and Manometric Study of the Pharynx and Esophagus

Stübgen

2007

Dysphagia

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The rigid spine syndrome (RSS) is not a recognized cause of dysphagia. The "vacuolar variant" of RSS causes mild, generalized, and slowly progressive weakness. Respiratory evaluation detected severe restrictive chest wall defect and significant respiratory muscle weakness. We identified nine patients at our Neuromuscular Clinic over a period of years. The aim of this evaluation was to ascertain whether pharyngoesophageal dysfunction caused cough (2/9), intermittent oropharyngeal dysphagia (4/9), and aspiration pneumonia (3/9). Pharyngeal and esophageal functions were evaluated separately by conventional cineradiography and intraluminal esophageal manometry over a one-year study period. An age-and gender-matched volunteer group without swallowing complaints partook in the manometric component of the study. There were seven male and two female patients. The mean age of patients was 19.1 years (17.8 years for controls), and the age range was 11-36 years (13-32 years for controls). The mean disease duration was 17.2 years (range = 8-31 years). Patients were commonly underweight (7/9). Cineradiology detected abnormal swallow physiology of pharyngeal striated muscle (1/9) and of esophageal smooth muscle (2/9). Mean manometric pressures in patients were not significantly different from control data. Manometry detected "nonspecific" contractility abnormalities (3/9) that were not reflected in the mean data. The relative lack of instrumental findings suggested minor upper alimentary tract dysmotility in patients with the RSS. The myopathy that underlies this syndrome likely caused dysfunction of the striated muscle of the pharyngeal constrictors and upper esophageal sphincter. The documented abnormalities of esophageal smooth muscle motility were nonspecific and tenuously associated with the muscle disorder. The incongruity between complaints of intermittent dysphagia and study results was perhaps due to transient pharyngoesophageal dysmotility, altered swallowing mechanics of limited cervical spine mobility, altered swallowing perception after previous intubation/tracheostomy, or a "functional" upper intestinal complaint. Joerg-Patrick Stübgen MD

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Modern solid state computerized manometry of the pharyngoesophageal segment

Cited by 93 publications

References 31 publications

Deglutitive upper esophageal sphincter relaxation: a study of 75 volunteer subjects using solid-state high-resolution manometry

Deglutitive upper esophageal sphincter relaxation: a study of 75 volunteer subjects using solid-state high-resolution manometry

Facioscapulohumeral Muscular Dystrophy: A Radiologic and Manometric Study of the Pharynx and Esophagus

Rigid Spine Syndrome: A Radiologic and Manometric Study of the Pharynx and Esophagus

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