Aging-related alterations in human upper esophageal sphincter function

Recent improvements in manometric catheters have made measurement of pharyngeal (P) and upper esophageal sphincter (UES) swallowing mechanics more reliable. Few studies have attempted to evaluate the effect of normal aging on P and UES mechanics. Pharyngeal and upper esophageal sphincter dynamics were studied in 10 healthy elderly adults (age greater than 60; range 62-79 yr) and 10 younger adults (age less than 60; range 24-59 yr). A solid-state intraluminal transducer system was used with a proximal unidirectional Konigsberg microtransducer and a circumferential (sphincter) transducer located 5 cm distally. Mean resting UES pressure was significantly (p less than 0.05) lower in the elderly than in the younger subjects (52 +/- 5 vs 72 +/- 6 (SE)) mm Hg. A significant inverse relation (R = -0.54; p less than 0.02) was found between age and resting UES pressure. Time from peak of pharyngeal contraction to UES nadir was significantly (p less than 0.05) shortened in the healthy elderly vs younger controls (10 +/- 30 vs 90 +/- 20 ms) during dry swallows. Our studies indicate that aging is associated with lower resting UES pressure and delayed UES relaxation, relative to the pharyngeal peak.     

Manometric characteristics of the upper esophageal sphincter recorded with a microsleeve

OBJECTIVES: We compared manometric recordings of the upper esophageal sphincter (UES) recorded with a miniature sleeve to those obtained using standard manometry. METHODS: The UES pressure of eight volunteer subjects was measured by station pull-through (SPT), by rapid pull-through (RPT), and with a microsleeve sensor for 30 min, followed by 15 min of esophageal acid infusion. Deglutitive UES relaxation recorded with a microsleeve and solid state sensor were compared. RESULTS: The UES pressure recorded with the microsleeve (25+/-9 mm Hg) was significantly less than that by SPT (114+/-18 mm Hg) or RPT (152+/-19 mm Hg), and was unaffected by acid infusion. Periods of low UES pressure were observed during long interswallow intervals (11+/-4, range 6-18 mm Hg). Deglutitive relaxation duration and intrabolus pressure measured with the microsleeve were less than those recorded by the solid state transducer. CONCLUSIONS: "Normal" UES pressure is heavily dependent on measurement technique; pressures obtained with a miniature sleeve are a fraction of those obtained by SPT or RPT. During periods of relative comfort with minimal swallowing, UES tone is approximately 10 mm Hg, similar to that during sleep. Volume modulation of deglutitive UES relaxation is demonstrable with a microsleeve, albeit with less precision than with a solid-state transducer.     

Do patients with globus sensation respond to hypnotically assisted relaxation therapy? A case series report

Globus sensation is a bothersome and difficult symptom to treat. The aims of this study were to evaluate the acceptability and utility of hypnotically‐assisted relaxation (HAR) in decreasing the perception of globus sensation and the effect of HAR on interdeglutitive upper esophageal sphincter (UES) pressure. Sixteen subjects with persistent globus sensation unresponsive to therapy for reflux disease and with normal esophageal/laryngeal imaging studies were invited to participate in a 7‐session clinical protocol. Before and after HAR, subjects completed standard questionnaires including the esophageal symptoms questionnaire. High‐resolution manometric assessment of respiratory augmentation and average resting UES pressure were assessed before and after HAR. Ten of the 16 subjects agreed to participate in the protocol. All participants were women with median age 51.5 (range 30–72 years). The participants found HAR acceptable and completed the entire 7‐session trial. Globus symptom severity varied widely pre‐treatment (median = 52.5, range 16–72), and 9 of 10 subjects reported a reduction in globus symptomatology following treatment (median = 14.0, range 3–19; P = .007). Only 1 subject exhibited abnormal respiratory augmentation of UES pressure (>27 mm Hg) prior to treatment and was normal following treatment (9.9 mm Hg). Resting UES pressure was normal in all subjects (<118 mm Hg). Group respiratory augmentation and average resting UES pressure were unaffected by HAR (P = .48, .89). This case series suggests that HAR can provide a substantial improvement in globus sensation irrespective of cause. UES function was unaffected. We suggest that HAR therapy is an acceptable and useful intervention for patients with globus sensation.     

Upper esophageal sphincter tone and reactivity to stress in patients with a history of globus sensation

Anxiety and abnormal upper esophageal sphincter function have been ascribed ill- defined roles in the etiology of globus sensation. In this study, we examined the psychological profile and effect of acute mental stress (dichotic listening task) on UES tone in seven patients reporting to the clinic with globus sensation and 13 healthy controls. Alterations in heart rate, blood pressure, frontalis EMG, and skin conductance confirmed the effectiveness of the stress test in patients and controls. During resting conditions, UES pressure (mean±SE) in patients (40.4±4.6 mm Hg) did not differ significantly from controls (46.5±4.7 mm Hg). In response to stress, UES pressure rose by 31% in patients (P=0.04) and by 25% in controls (P=0.002). The stress- induced rise in UES pressure in patients (9.5±3.8 mm Hg) was not significantly different to that observed in controls (11.8±3.0 mm Hg). Psychological profiles of globus patients presenting to the clinic revealed them to be more introverted, anxious, neurotic, and depressed than normal controls. We conclude that in patients with a history of globus sensation, resting UES pressure and its response to stress is normal. Although individuals presenting to the clinic with globus sensation showed increased levels of psychoneurosis, acute, predictable stress is not a factor in the genesis of globus sensation. UES hyperresponsiveness to other stimuli or subjective intolerance to changes in UES pressure could account for symptoms of globus sensation.Dr. Cook is supported by a University of Sydney, Postgraduate Medical Foundation Award. Dr. Dent was supported as a Visiting Professor to McMaster University by a Visiting Scientist Award from the Canadian Medical Research Council.     

Clinical and experimental studies on the efficiency of nifedipine on smooth muscle strips of the esophagus (author's transl)

Based on in vivo studies on isolated muscle strips of the LES and on manometric in vivo studies on 8 mongrel dogs, 6 healthy volunteers, 6 patients with achalasia and 3 subjects with diffuse esophageal spasm we could demonstrate that nifedipine causes a long-lasting relaxation of smooth muscle, the esophagus and LES. In 8 dogs resting pressure at the LES was decreased by 20 mg nifedipine from 18.5 +/- 1.8 mm Hg to 8.2 +/- 0.9 mm Hg. This pressure decrease could not be reversed by pentagastrin stimulation (3.0 microgram/kg KG PG). The resting pressure in LES was decreased from 26.8 +/- 3.8 mm Hg to 16.4 +/- 2.1 mm Hg in healthy volunteers and from 45.5 +/- 2.6 mm Hg to 14.5 +/- 0.4 mm Hg in patients with achalasia. In 3 patients with diffuse esophageal spasm nifedipine (20 mg) caused a mean decrease of 38% of the contraction amplitude. Further clinical studies have to be done to clarify if the spasmolysis by nifedipine may be important in the treatment of spastic or hypertonic motility disorders of the LES and the esophagus.     

Esophageal manometry: a comparison of findings in younger and older patients

Objective: We sought to determine the utility of esophageal manometry in an older patient population.
Methods: Consecutively performed manometry studies (470) were reviewed and two groups were chosen for the study, those ≥ 75 yr of age (66 patients) and those ≤ 50 years (122 patients). Symptoms, manometric findings (lower esophageal sphincter [LES], esophageal body, upper esophageal sphincter [UES]) and diagnoses were compared between the groups.
Results: Dysphagia was more common (60.6% vs 25.4%), and chest pain was less common (17.9 vs 26.2%) in older patients. In the entire group, there were no differences in LES parameters. Older patients with achalasia had lower LES residual pressures after deglutition (2.7 vs 12.0 mm Hg), but had similar resting pressures (31.4 vs 35.2 mm Hg) compared with younger achalasia patients. Duration and amplitude of peristalsis were similar in both groups, whereas peristaltic sequences were more likely to be simultaneous in the older group (15% vs 4%). The UES had a lower resting pressure in the older patients (49.6 vs 77.6 mm Hg) and a higher residual pressure (2.0 vs −2.7 mm Hg). The older patients were less likely to have normal motility (30.3% vs 44.3%) and were more likely to have achalasia (15.2% vs 4.1%) or diffuse esophageal spasm (16.6% vs 5.0%). When only patients with dysphagia were analyzed, achalasia was still more likely in the older group (20.0% vs 12.9%).
Conclusions: When older patients present with dysphagia, esophageal manometry frequently yields a diagnosis to help explain their symptoms.     

Globus Sensation Is Associated with Hypertensive Upper Esophageal Sphincter but Not with Gastroesophageal Reflux

Globus sensation (globus) is best described asa constant feeling of a lump or fullness in the throat.Although the etiology of globus remains unclear, it hasbeen attributed to a hypertensive upper esophageal sphincter (UES) resting pressure and togastroesophageal reflux (GER). The aim of this studywas, therefore, to determine if significant associationsexisted among globus, UES resting pressure, and GER. We reviewed the records of all patients who hadstationary esophageal manometry over a 21 -year intervalwith specific attention to symptoms of globus, UESpressures, and ambulatory pH studies. Patients with hypotensive UES (<30 mm Hg) wereexcluded. Chi square (²) test was usedto determine significant associations. Six hundred fiftypatients had normal UES resting pressures and 101patients had hypertensive UES (>118 mm Hg). Seventeen ofthe 650 (3%) (16 women/1 man; mean age: 48, range 32-81years) with normal UES described globus. Conversely, 28of the 101 (28%) (15 women/13 men; mean age: 43, range 23- 61 years) patients withhypertensive UES described globus. There was asignificant association between hypertonicity of the UESand globus (² = 93.42, P < 0.0001).In patients with normal UES, globus occurred predominantly infemales (² = 6.33, P < 0.01).Twenty-three (16 women/7 men; mean age: 43, range 23-60years) of the 45 patients with globus had priorambulatory pH studies. Six of 23 (26%) had GER. Compared to an age-,sex-, and UES-pressure-matched group of 23 patients (16women/7 men; mean age: 44, range 22-75 years) withoutglobus, nine (39%) had GER, thus showing no significant association of globus with GER (P = 0.35).There also was no significant association of GER withnormal UES or with hypertensive UES in these patients.In conclusion, there is a significant association between hypertensive UES and globus. The datasuggest two possible etiologies: female patients withnormal UES pressure potentially having increasedafferent sensation and a group with equal sexdistribution but abnormally elevated UES resting pressure.This study does not support GER as an etiology ofglobus.     

Laryngo-upper esophageal sphincter contractile reflex in humans deteriorates with age

BACKGROUND & AIMS: Recent studies have shown the existence of several reflex connections between the aerodigestive and upper gastrointestinal tracts. Our aim was to study the effect of laryngeal stimulation on upper esophageal sphincter (UES) pressure and to determine the reproducibility of this effect. METHODS: We studied 14 young and 10 elderly healthy nonsmoker volunteers and 7 patients with UES dysphagia using a concurrent manometric and video endoscopic technique. Three levels of laryngeal air stimulation were studied: 6 mm Hg/50 ms, 10 mm Hg/50 ms, and 6 mm Hg/2 s. Ten young subjects were studied twice. RESULTS: For 6-mm Hg/2-s and 6-mm Hg/50-ms duration stimuli, the frequency of UES response to air stimulation as evidenced by mucosal deflection (response/deflection ratio) in the elderly volunteers was significantly lower compared with that of young subjects (P < 0.05). The response/deflection ratio of the 6-mm Hg/2-s stimulus was significantly higher than those induced by stimuli of shorter duration (P < 0.01). Poststimulation UES pressure was significantly higher than prestimulation pressure (P < 0.05) in both groups. The magnitude of the increase in poststimulation UES pressure in the elderly volunteers was similar to that of the young subjects. Findings were similar in repeated studies. Four of 7 dysphagic patients exhibited an abnormal response. CONCLUSIONS: Afferent signals originating from the larynx reproducibly induce contraction of the UES: the laryngo-UES contractile reflex. This reflex is elicited most reliably by 6-mm Hg/2-s air stimulation. Frequency elicitation of this reflex decreases significantly with age while the magnitude of change in UES pressure remains unchanged, indicating a deleterious effect of aging on the afferent arm of this reflex. This reflex is altered in some dysphagic patients.     

Deterioration of esophageal motility with age: a manometric study of 79 healthy subjects

OBJECTIVE: Data are limited on the effect of age on esophageal function. We evaluated whether aging influences the motor activity of the esophagus. METHODS: Standard esophageal manometry was performed in 79 healthy, nonpaid volunteers of both sexes, 18-73 yr of age. Lower (LES) and upper esophageal sphincter (UES) characteristics and the properties of esophageal peristaltic waves were assessed by age groups: < or = 25 yr, 26-35 yr, 36-45 yr, 46-55 yr, 56-65 yr, and > 65 yr. RESULTS: Age correlated inversely with LES pressure and length, UES pressure and length, and peristaltic wave amplitude and velocity, and correlated directly with the proportion of simultaneous contractions. Age was inversely correlated with the upper limits of normality (95th percentiles) of LES pressure (r = -0.943, p = 0.005), UES pressure (r = -0.943, p = 0.005), middle and lower peristaltic wave amplitude (r = -0.947, p = 0.004, and r = -0.844, p = 0.035, respectively), upper/middle peristaltic progression speed (r = -0.943, p = 0.005), and the proportion of simultaneous contractions (r = 0.926, p = 0.008), but not with the lower normal limits (5th percentiles) of these variables. Gender did not affect esophageal motility variables. The 95th percentiles of LES pressure differed by 20 mm Hg, those of lower peristaltic amplitude by 82 mm Hg, and those of percent simultaneous contractions by a factor of 2, between the younger and the older age groups. CONCLUSIONS: The results suggest that normal esophageal motility deteriorates with advancing age. Thus, age-related normality limits of esophageal pressures should be considered before establishing the manometric diagnosis of hypercontractile esophageal motility disorders.     

Dilatation therapy for dysphagia in patients with upper esophageal sphincter dysfunction--manometric and symptomatic response.

Inability to maintain oral nutrition due to oropharyngeal dysphagia is common in patients with a variety of neurological and neuromuscular disorders and severely affects quality of life. Cricopharyngeal dilatation has been used as empiric therapy in these patients, but little data exist on symptom response and there is no data on the effect on the manometric characteristics of the upper esophageal sphincter (UES) and pharynx. We studied 10 patients with oropharyngeal dysphagia and either elevated upper esophageal sphincter resting pressure, or a high residual pressure or attenuated duration of relaxation on swallowing. Dilatation therapy was performed with an 18-20 mm Savary dilator and manometry was repeated after an average period of 4 weeks. Nine out of 10 patients had improvement in dysphagia and have maintained oral nutrition for a mean follow-up of 13 months. UES residual pressure decreased in nine out of 10 patients and the group median value decreased significantly from 10.8 mmHg pretreatment to 5.7 mmHg after therapy (P < 0.05). UES resting pressure decreased in eight out of 10 patients and the group median value decreased from 82 to 43 mmHg (P < 0.05). Duration of relaxation did not change significantly. Videoradiography was normal in five out of nine responders to therapy. For selected patients with oropharyngeal dysphagia and manometric signs of UES dysfunction, dilatation therapy may give excellent symptomatic relief, apparently by reducing UES resting pressure and/or increasing the duration and completeness of relaxation.     

Esophageal manometry

Pressure transients in the pharyngoesophagus vary widely, from about 2500 mm Hg/sec in the pharynx to 150 mm Hg/sec in the lower esophageal sphincter (LES). Perfused side-hole and Dent-sleeve manometry have limitations with respect to their inability to record pharyngeal pressure transients and their relative inability to record abrupt pressure increases in the upper esophageal sphincter (UES), although falling pressure changes, ie, relaxations, of more than 1000 mm Hg/sec can be detected easily by the Dent sleeve. Hence, accurate pharyngeal and UES recordings require pressure sensors that are able to record pressure transients faster than 2500 mm Hg/sec. Microtransducers meet this requirement. Except for their relatively high costs of acquisition, microtransducers have a lot of advantages in comparison with the perfused side-hole methods: the small outer diameter and flexibility enable easy intubation; baseline pressures are not affected by subject position; and plumbing necessary for infusion is eliminated. After presoaking in water, calibration is stable and the baseline drift is acceptable. They have an excellent linearity and a negligible hysteresis. Their durability is satisfactory. The microtransducer assemblies can be designed in almost any configuration and even circumferentially sensitive microtransducers for acute sphincter measurements have been developed. For long-interval recordings of the UES and the LES, however, microtransducers are not suitable: for these the Dent sleeve is required. Recently, microtransducers have been used more frequently because they are indispensable in the 24-hr ambulatory esophageal manometry technology.     

Cholecystokinin is not a major hormonal regulator of lower esophageal sphincter pressure

Although injection of cholecystokinin can reduce resting lower esophageal sphincter pressure, the physiological significance of this finding has not been established. The purpose of this double-blind crossover study was to determine the effect of physiological plasma levels of cholecystokinin on resting lower esophageal sphincter pressure. Eighteen normal male volunteers were studied on two separate days. Following a 20-minute baseline period, subjects received infusions of saline or synthetic cholecystokinin-8 at increasing rates. Basal plasma cholecystokinin levels averaged 1.3 +/- 0.2 pmol/L (mean +/- SE) and increased to levels of 7.4 +/- 0.9 pmol/L, 12.1 +/- 2.4 pmol/L, and 23.1 +/- 3.8 pmol/L during cholecystokinin infusion rates of 21, 42, and 84 pmol/min, respectively. Lower esophageal sphincter pressure was recorded continuously with a sleeved catheter. Basal lower esophageal sphincter pressure averaged 19.9 mm Hg and did not change with the first infusion, which produced physiological peak postprandial plasma levels of cholecystokinin. Lower esophageal sphincter pressure declined only during the infusions that produced plasma cholecystokinin levels two to four times greater than normal peak postprandial levels. Since infusion of cholecystokinin to levels that reproduce physiological blood levels does not significantly decrease lower esophageal sphincter pressure, it was concluded that cholecystokinin is not a major hormonal regulator of lower esophageal sphincter relaxation.     

Mechanism of hind limb vasoconstriction due to cyclosporin A in the dog.

Cyclosporin A (CSA) causes an acute vasoconstriction of hind limb arterial vessels. To determine the mechanism of action of CSA on the peripheral arterial bed, studies were performed on the isolated femoral artery perfused at constant flow in 61 dogs. Changes in femoral perfusion pressure reflected variations in vascular resistance. Pure powder CSA was dissolved in autologous blood and injected at doses of 1, 5, 10, and 20 mg. Infusions of 1 and 5 mg CSA caused nonsignificant mean increases of 4 +/- 2 mm Hg (95% confidence interval [CI], 0-8; p > 0.05) and 10 +/- 4 mm Hg (95% CI, 0-21; p > 0.05) in femoral perfusion pressure, with CSA blood levels in the femoral vein averaging 40 +/- 16 and 126 +/- 50 nmol/l, respectively, at the end of the injections. Infusions of 10 and 20 mg CSA caused significant increases in femoral perfusion pressure averaging of 8 +/- 3 mm Hg (95% CI, 1-14; p < 0.05) and 20 +/- 4 mm Hg (95% CI, 11-29; p < 0.05) in femoral perfusion pressure. CSA blood levels at the end of injections averaged 271 +/- 99 and 431 +/- 146 nmol/l, respectively, in the femoral vein. Blockade of alpha-adrenergic receptors with phentolamine and surgical lumbar sympathectomy decreased significantly the CSA vasoconstrictive effect in peripheral arterial vessels, with increases in perfusion pressure averaging 29 +/- 5 mm Hg before and 14 +/- 3 mm Hg after phentolamine (p < 0.05) and 30 +/- 2 mm Hg before and 8 +/- 2 mm Hg after sympathectomy (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Manometric follow-up after resection of Zenker's diverticulum]

Since 1977, 15 patients have undergone surgery for Zenker's diverticula at the University of Würzburg Department of Surgery. We were able to follow up 6 of them after an average of 4 years (5 months to 10.5 years). Preoperative manometric findings available on one patient revealed markedly impaired coordination between pharyngeal contraction and relaxation of the upper esophageal sphincter. After resection of the diverticulum and myotomy of the upper sphincter this was not observed in any of the patients. Myotomy also was followed by significant lowering of resting pressure in the upper esophageal sphincter to mean levels of 18 mm Hg (normally 90-100 mm Hg). By contrast, one patient who did not undergo intraoperative myotomy had only a moderate reduction of resting pressure (to 30-45 mm Hg) and a normal maximum contraction pressure of 100 mm Hg. This patient developed a relapse. Our manometric evidence underscores the importance of intraoperative myotomy as an adjunctive procedure in diverticulum resection. By helping reduce the resistance imposed by interference of impaired coordination with pharyngeal contraction, it also results in a lower rate of relapse.     

Intraesophageal pressure during esophageal speech in laryngectomized patients rehabilitated or no rehabilitated for oral communication

BACKGROUND: After laryngectomy for treatment of pharyngeal/laryngeal carcinomas the patients may be rehabilitated, for oral communication, with the esophageal speech. AIM: To study the intra-esophageal pressure during the esophageal speech. PATIENTS AND METHODS: It was measured the intra-esophageal pressure in 25 laryngectomized patients aged 40 to 70 years (median 57 years), 10 rehabilitated with esophageal speech and 15 unable to do so. The manometric method with continuous perfusion was used. The esophageal pressures was measured 3 to 5 cm below the upper esophageal sphincter when the patients tried to speak the vowel "a". Sometimes the air swallowed went to the stomach, with a peristaltic or simultaneous contraction in the esophageal body. RESULTS: During the attempt of esophageal speech the intra-esophageal pressure was higher in patients able to have esophageal speech (26.4 +/- 10.1 mm Hg, mean +/- SD) than in patients unable to do so (13.7 +/- 7.2 mm Hg). The esophageal contraction after a swallow of air was also higher in patients with esophageal speech (45.3 +/- 8.6 mm Hg) than in patients unable to do so (33.8 +/- 13.1 mm Hg). CONCLUSION: Laryngectomized patients rehabilitated with esophageal speech has a higher intra-esophageal pressure during speech than patients unable to do so, what may be consequence of the capacity to retain air inside the esophagus.     

Normalization of impaired coronary circulation in hypertrophied rat hearts

We tested the hypothesis that impaired coronary autoregulation, decreased flow reserve, and diminished reactive hyperemic response in hypertrophied hearts with coronary arterial hypertension may be reversible after relief of pressure overload. In 4-week ascending aortic banded rats, in vivo peak systolic left ventricular pressure increased to 178 +/- 8 mm Hg (103 +/- 6 mm Hg in sham-operated control group). This increased pressure produced myocardial hypertrophy, and the left ventricular weight/body weight ratio was 46% above that of the control group. After the rats were killed, the coronary perfusion pressure-flow relations were obtained during resting conditions and maximal vasodilation after a 40-second period of ischemia in beating but nonworking isolated hearts perfused with Tyrode's solution with bovine red blood cells and albumin. In hearts from control rats, coronary autoregulation (i.e., a slight decrease in flow with reduction of pressure) was observed in the range of 50-100 mm Hg of perfusion pressure. A pronounced reactive hyperemic response was observed: a peak flow/resting flow ratio of 2.9 +/- 0.1 and a repayment ratio of 1.7 +/- 0.2 at 100 mm Hg of perfusion pressure. In hearts of banded rats the resting pressure-flow relation was rectilinear in the range of 25-175 mm Hg of perfusion pressure. Flow reserve and the time of reactive hyperemia to one half peak flow decreased at 50, 100, and 150 mm Hg of perfusion pressure compared with values in control rat hearts. Four weeks after debanding, peak systolic left ventricular pressure and cardiac hypertrophy had normalized. The impaired autoregulation, decreased flow reserve, and diminished reactive hyperemic response had completely reversed.(ABSTRACT TRUNCATED AT 250 WORDS)     

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

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.     

Effect of age on differences in upper esophageal sphincter and pharynx pressures between patients with dysphagia and control subjects

OBJECTIVES: The aim of this study was to explore the effect of age and food consistency on manometric data of the swallow sequence in patients with dysphagia. METHODS: Manometric data from 41 patients (age range, 32-88 yr) and 41 age-matched control subjects was examined for differences between subgroups < 60 yr and > or = 60 yr of age, as well as for changes with food consistency. RESULTS: Only pharynx peak pressure showed an age-dependent decrease (144.1 +/- 21.4 mm Hg vs 95.8 +/- 15.1 mm Hg, p < 0.05) in patients. Significant higher upper esophageal sphincter residual pressure and delayed onset of upper esophageal sphincter relaxation were noted in patients aged <60 yr compared to age-matched controls, whereas only pharynx peak pressure was significantly lower in patients compared to controls aged > or = 60 yr. Food consistency did not have a consistent effect on manometric results in patients with dysphagia. CONCLUSIONS: This is the first study to systematically explore the influence of age and food consistency on manometric parameters in dysphagia patients. These results may provide useful insights when identifying actual manometric abnormalities in patients with dysphagia. They also suggest possible different underlying mechanisms of dysphagia in younger versus older patients.     

A new evaluation of the upper esophageal sphincter using the functional lumen imaging probe: a preliminary report

Objective and reliable evaluation of upper esophageal sphincter (UES) opening during swallowing based on videofluoroscopy and pharyngeal manometry challenges dysphagia clinicians. The functional lumen imaging probe (FLIP) is a portable tool based on impedance planimetry originally designed to measure esophogastric junction compliance. It is hypothesized that FLIP can evaluate UES distensibility, and can provide UES diameter and pressure measurements at rest, during swallowing, and during voluntary maneuvers. Eleven healthy adult subjects consented to FLIP evaluation. The probe was inserted transorally, and the balloon was positioned across the UES. Two 20‐mL ramp distensions were completed. Changes in UES diameter and intraballoon pressure were measured during dry and 5‐mL liquid swallows, and during voluntary swallow postures and maneuvers employed in clinical practice. The protocol was completed by 10 of 11 healthy subjects. Mean intraballoon pressure increased throughout 5‐mL (5.8 mmHg; ?4.5–18.6 mmHg), 10‐mL (8.7 mmHg; 2.3–28.5 mmHg), 15‐mL (17.3 mmHg; 9.5–34.8 mmHg), and 20‐mL (31.2 mmHg; 16–46.3 mmHg) balloon volumes. Mean resting UES diameter (4.9 mm) increased during dry swallows (9.2 mm) and 5‐mL liquid swallows (7.7 mm). Mean UES diameter increased during 5‐mL liquid swallows with head turn to right (8.1 mm) and left (8.3 mm), chin tuck (8.4 mm), effortful swallow (8.5 mm), Mendelsohn maneuver (8.1 mm), and supraglottic swallow (7.8 mm). FLIP was safely inserted and distended in the UES, and provided useful quantitative data regarding UES distensibility and UES diameter changes during swallowing maneuvers. Further research is being conducted to explore the role of FLIP in UES evaluation.     

Genesis of basal sphincter pressure: effect of tetrodotoxin on lower esophageal sphincter pressure in opossum in vivo.

Currently it is believed that lower esophageal sphincter closure is maintained by tonic neurohormonal activity. Studies were performed to evaluate the role of neural and myogenic activity in the genesis of resting sphincter pressure in the opossum. The neural activity in the sphincter was blocked by intravenous administration of the puffer fish poison, tetrodotoxin, in intact animals. The respiration in these animals was assisted with a respirator, their blood pressure was supported by intravenous administration of Ringer's solution, and their body temperature was maintained by heating lamp. The lower esophageal sphincter pressures were measured with water-filled and continuously perfused catheters which were anchored to the lower esophageal sphincter using a new technique. Tetrodotoxin blocked the sphincter response to neural stimulation with vagal stimulation, esophageal distention, and local electrical stimulation of the sphincter. The mean resting sphincter pressure before tetrodotoxin was 59.0 +/- 2.6 mm Hg, and it was 64.4 +/- 6.9 mm Hg after tetrodotoxin (P greater than 0.05). During neural block with tetrodotoxin, the sphincter response to administration of isoproterenol or bethanechol was similar to that during the control period (P greater than 0.05). These studies show that: (1) Tetrodotoxin can be administered in intact animals to achieve complete block of neural activity in the lower esophageal sphincter; (2) sphincter muscle is not adversely affected by tetrodotoxin; and (3) block of neural activity does not alter the resting lower esophageal sphincter pressure.