Normal values for esophageal high‐resolution manometry

Bogte, Auke; Bredenoord, Albert J.; Oors, Jac; Siersema, PD; Smout, A. J. P. M.

doi:10.1111/nmo.12167

Cited by 81 publications

(99 citation statements)

References 11 publications

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“…Patients fasted overnight then the catheter was placed transnasally, positioned to record from the hypopharynx to the stomach. The manometric protocol was done with patients supine and consisted of a 5-min period to assess basal sphincter pressures, and ten 5-mL water swallows[15-17]. Data were analyzed by a SP, who was blinded to the results of pH tracings, using a dedicated software program (Medical Measurement System Database Software, V8.23a, The Netherlands).…”

Section: Methodsmentioning

confidence: 99%

Oropharyngeal acid reflux and motility abnormalities of the proximal esophagus

Passaretti

Mazzoleni

Vailati

et al. 2016

WJG

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AIMTo investigate the relationship between pathological oropharyngeal (OP) acid exposure and esophageal motility in patients with extra-esophageal syndromes.METHODSIn this prospective study we enrolled consecutive outpatients with extra-esophageal symptoms suspected to be related to gastroesophageal reflux disease (GERD). We enrolled only patients with a reflux symptom index (RSI) score-higher than 13 and with previous lung, allergy and ear, nose and throat evaluations excluding other specific diagnoses. All patients underwent 24-h OP pH-metry with the Dx probe and esophageal high-resolution manometry (HRM). Patients were divided into two groups on the basis of a normal or pathological pH-metric finding (Ryan Score) and all manometric characteristics of the two groups were compared.RESULTSWe examined 135 patients with chronic extra-esophageal syndromes. Fifty-one were considered eligible for the study. Of these, 42 decided to participate in the protocol. Patients were divided into two groups on the basis of normal or pathological OP acid exposure. All the HRM parameters were compared for the two groups. Significant differences were found in the median upper esophageal sphincter resting pressure (median 71 mmHg vs 126 mmHg, P = 0.004) and the median proximal contractile integral (median 215.5 cm•mmHg•s vs 313.5 cm•mmHg•s, P = 0.039), both being lower in the group with pathological OP acid exposure, and the number of contractions with small or large breaks, which were more frequent in the same group. This group also had a larger number of peristaltic contractions with breaks in the 20 mmHg isobaric contour (38.7% vs 15.38%, P < 0.0001).CONCLUSIONIn patients with suspected GERD-related extra-esophageal syndromes pathological OP acid exposure was associated with weaker proximal esophageal motility.

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Section: Methodsmentioning

confidence: 99%

Oropharyngeal acid reflux and motility abnormalities of the proximal esophagus

Passaretti

Mazzoleni

Vailati

et al. 2016

WJG

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“…Proposed metrics under discussion include mean inspiratory pressure, mean expiratory pressure, the extent and variability of the separation between the lower esophageal sphincter and crural diaphragm (LES-CD separation), and the EGJ contractile integral (EGJ-CI), all of which have been used in publications. However, discrepancies exist in the details of calculation methodology for these metrics, the strength of data supporting their utility, and their normative ranges among HRM devices 4–11 , all important limitations meriting further consideration.…”

Section: Metrics and Swallow Pattern Characterizationmentioning

confidence: 99%

The Chicago Classification of Motility Disorders

Roman

Gyawali

Xiao

et al. 2014

Gastrointestinal Endoscopy Clinics of North America

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Synopsis The Chicago Classification defines esophageal motility disorders in high resolution manometry using Clouse plots. This is based on individual scoring of 10 swallows performed in supine position. The update version of the Chicago Classification, named Chicago Classification v3.0, has many new revisions that will improve and simplify the current version. Disorders of EGJ outflow obstruction are defined by a median integrated relaxation pressure (IRP) above the limit of normal and further divided into 3 achalasia subtypes and EGJ outflow obstruction. In case of 100% failed contractions, achalasia should be considered if there is a borderline IRP or evidence of panesophageal pressurization. Major motility disorders (aperistalsis, distal esophageal spasm, and hypercontractile or jackhammer esophagus) are patterns not encountered in controls in the context of normal EGJ relaxation. Compared to the previous version of the Chicago Classification, failed contraction corresponds to a contraction with a distal contractile integral (DCI) below 100 mmHg-s-cm, as opposed to an isobaric contour plot definition. At least 2 hypercontractile swallows (DCI > 8,000 mmHg-s-cm) are required for the diagnosis of jackhammer esophagus in the Chicago Classification v3.0. Finally with the latest version of the Chicago Classification, only two minor motor disorders are now considered. Ineffective esophageal motility (IEM) is defined as at least 50% of swallows with a DCI below 450 mmHg-s-cm. Fragmented peristalsis is defined as at least 50% of fragmented swallows (that are contractions with DCI>450 mmHg-s-cm and break > 5 cm in the 20-mmHg isobaric contour) not meeting IEM criteria.

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“…Previously, IBP has been reported as a single point in space and time that lies somewhere between the bolus head and tail (4, 7-12), sometimes as the averaged pressure between the bolus head and tail (6). The few explorations of pharyngeal IBP using high-resolution manometry (HRM) have focused on one time point and one physiological sensor region (6, 13).…”

Section: Introductionmentioning

confidence: 99%

Pharyngeal Pressure and Timing During Bolus Transit

2016

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Determining intrabolus pressure (IBP) at the upper esophageal sphincter (UES) and in the esophagus has given compelling evidence that IBP can be a predictor for swallowing dysfunction. Studies have looked most superiorly at the low hypopharynx region but there has been no inquiry into what IBP measures throughout the entire pharynx can tell us. We present a study to describe the pressures within and surrounding the moving bolus throughout the pharynx and into the UES. Simultaneous HRM and videofluoroscopy were performed in 10 healthy subjects swallowing ten 10 mL thin-liquid barium boluses. Three events surrounding bolus movement were tracked via videofluoroscopy, two additional events were found using manometric measures. As the bolus passes through the pharynx, low pressure is created at and below the head of the bolus. A modest pressure increase is seen as the bolus passes through the pharynx and finally, high pressure is observed at the bolus tail, followed by an even larger pressure generation of a clearance event. HRM allows for greater resolution in data collection in the pharynx and in this study, aided in identifying semi unique characteristics around the hypopharynx and the UES which are consistent with the complex anatomy of the regions and the transition of the UES from active closure to relaxed opening. In the future, additional studies designed to look at aged and diseased populations may lead to better understanding of disease etiology, and treatment options.

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Normal values for esophageal high‐resolution manometry

Cited by 81 publications

References 11 publications

Oropharyngeal acid reflux and motility abnormalities of the proximal esophagus

Oropharyngeal acid reflux and motility abnormalities of the proximal esophagus

The Chicago Classification of Motility Disorders

Pharyngeal Pressure and Timing During Bolus Transit

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