The Pharyngoesophageal Closure Mechanism: A Manometric Study

Winans, Charles S.

doi:10.1016/s0016-5085(19)33209-3

Cited by 160 publications

(35 citation statements)

References 11 publications

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“…In intubated patients with severe h-ARF undergoing PSV, Patroniti et al [19] found that increasing the airway pressure up to 38 ± 3.2 cmH 2 O for 3-5 s was effective in ameliorating oxygenation. This amount of pressure, however, would exceed the resting upper esophageal opening pressure [30] and cause gastric distension if applied through a noninvasive interface [31,32]. Brochard et al [33] did not observe gastric distension when the peak airway pressure did not exceed 25 cmH 2 O.…”

Section: Discussionmentioning

confidence: 98%

Influence of lung collapse distribution on the physiologic response to recruitment maneuvers during noninvasive continuous positive airway pressure

et al. 2011

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Section: Discussionmentioning

confidence: 98%

Influence of lung collapse distribution on the physiologic response to recruitment maneuvers during noninvasive continuous positive airway pressure

et al. 2011

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“…The pressure profile within the UES is asymmetric, with the highest pressures recorded in the anterioposterior direction of the cricopharyngeal muscle [16,18]. The UES is a several-centimeterslong high-pressure zone, with a distinct maximum pressure at the level of the cricopharyngeal muscle during rest [16].…”

Section: Performance Of the Balloon System In Healthy Volunteersmentioning

confidence: 99%

“…There is also pressure asymmetry during deglutition. Pharyngoesophageal closure is achieved by a force not uniformly distributed about the circumference [5,18]. In addition, the UES moves in the cranial direction during swallowing as a result of the transient laryngeal elevation.…”

Section: Performance Of the Balloon System In Healthy Volunteersmentioning

confidence: 99%

Monitoring of Pharyngeal and Upper Esophageal Sphincter Activity with an Arterial Dilation Balloon Catheter

2007

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In patients with dysphagia and radiologic signs of dysfunction of the upper esophageal sphincter (UES), manometry is helpful in giving a better understanding of muscular activity during swallowing. Traditional manometric methods include use of perfusion catheters or solid-state intraluminal strain gauges. The rapid and asymmetric pressure variations in the UES and difficulties compensating for the pharyngolaryngeal elevation during swallowing limit the value of these methods. We used an arterial balloon dilation catheter as a probe in manometric recording of the UES in 28 healthy volunteers. Simultaneous perfusion manometry of the pharynx with the same catheter was performed to assess the coordination of the muscular activity in the esophageal entrance during swallowing. The catheter was well tolerated by all subjects. We found an average resting pressure in the UES of 31.0 mmHg, and the average maximum pressure during contraction was 89.0 mmHg. The average duration of the swallowing act was 3.9 s. All subjects displayed a complete UES relaxation and a normal coordination of propagated pressure in the hypopharynx and UES. The results were highly reproducible and the interindividual range was low. Arterial dilation catheters are safe and have suitable physical properties for pressure monitoring in the UES.

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“…There were significant differences in sphincter pressure recorded by the three catheters either when their orifices were set 5 cm apart longitudinally or when they were at the same level, equidistant around the circumference of a circle. This indicates that spatial orientation of catheter tips influences the pressure recorded from a sphincter.The upper oesophageal sphincter (cricopharyngeal sphincter) has received less attention than the lower oesophageal sphincter, although studies of its normal and abnormal behaviour have been published (Lund, 1965;Code and Schlegel, 1967;Hunt, Connell, and Smiley, 1970;Ellis, 1971;Winans, 1972). Hunt et al (1970) suggested that its resting pressure was higher in patients with gastro-oesophageal reflux than in normal subjects.…”

mentioning

confidence: 99%

“…The upper oesophageal sphincter (cricopharyngeal sphincter) has received less attention than the lower oesophageal sphincter, although studies of its normal and abnormal behaviour have been published (Lund, 1965;Code and Schlegel, 1967;Hunt, Connell, and Smiley, 1970;Ellis, 1971;Winans, 1972). Hunt et al (1970) suggested that its resting pressure was higher in patients with gastro-oesophageal reflux than in normal subjects.…”

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confidence: 99%

Upper oesophageal sphincter yield pressure in normal subjects and in patients with gastro-oesophageal reflux

Stanciu

Bennett

1974

Thorax

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. (1974). Thorax, 29,[459][460][461][462]. Upper oesophageal sphincter yield pressure in normal subjects and in patients with gastro-oesophageal reflux. Upper oesophageal sphincter yield pressure was measured in 26 normal subjects and in 69 patients with gastro-oesophageal reflux, using a system of continuously perfused catheters. There was no significant difference between the two groups. Perfusion of the oesophagus with hydrochloric acid produced no change in sphincter pressure. The resting sphincter pressure was not related to the degree of oesophagitis nor to the severity of reflux as measured by 15-hour pH recordings. There were significant differences in sphincter pressure recorded by the three catheters either when their orifices were set 5 cm apart longitudinally or when they were at the same level, equidistant around the circumference of a circle. This indicates that spatial orientation of catheter tips influences the pressure recorded from a sphincter.The upper oesophageal sphincter (cricopharyngeal sphincter) has received less attention than the lower oesophageal sphincter, although studies of its normal and abnormal behaviour have been published (Lund, 1965;Code and Schlegel, 1967;Hunt, Connell, and Smiley, 1970;Ellis, 1971;Winans, 1972). Hunt et al. (1970) suggested that its resting pressure was higher in patients with gastro-oesophageal reflux than in normal subjects.In this paper we examine the relationships between the resting upper sphincter yield pressure, the degree of oesophagitis, and the severity of gastro-oesophageal reflux. MATERIALS AND METHODSStudies were made of 26 normal volunteers (16 men, 10 women) aged 18-41 years (mean 32-1) and of 69 patients (39 men, 30 women) aged 17-70 years (mean 40 8) with heartburn and acid regurgitation related to posture and meals. Among the latter group radiology showed 21 to have hiatus hernia and/or gastrooesophageal reflux.Sphincter pressure was measured with three polyvinyl catheters (1-2 mm internal diameter) bound together with single side-holes 5 cm apart. The catheters were continuously perfused with distilled water at a rate of 0-8 ml/min by a syringe pump and were connected to Bell and Howell transducers, the output of which was recorded on a Devices M.19 multichannel direct-writing recorder. Respiration was monitored by a belt pneumograph. The catheters were passed via the nose into the stomach. With the patient supine and the transducers level with the posterior axillary line, they were then withdrawn in steps of 0 5 cm. Once a catheter tip was in the pharynx, perfusion was stopped to prevent coughing. In each subject the mean upper sphincter pressure was calculated (taking end-expiratory oesophageal pressure as zero).In eight normal subjects and six patients with reflux the manometric characteristics of the upper sphincter were studied with three continuously perfused catheters whose side-openings were at the same level, equidistant around the circumference of a circle.In six normal subjects and nine patients with reflux, the sphincter press...

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The Pharyngoesophageal Closure Mechanism: A Manometric Study

Cited by 160 publications

References 11 publications

Influence of lung collapse distribution on the physiologic response to recruitment maneuvers during noninvasive continuous positive airway pressure

Influence of lung collapse distribution on the physiologic response to recruitment maneuvers during noninvasive continuous positive airway pressure

Monitoring of Pharyngeal and Upper Esophageal Sphincter Activity with an Arterial Dilation Balloon Catheter

Upper oesophageal sphincter yield pressure in normal subjects and in patients with gastro-oesophageal reflux

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