Esophageal function testing with combined multichannel intraluminal impedance and manometry: multicenter study in healthy volunteers.

BACKGROUND & AIMS: Combined multichannel intraluminal impedance and manometry (MII-EM) assesses esophageal function by simultaneous measurement of both pressure and bolus transit. Normative data for this method have not been published. The aim of this study was to establish normative data for combined MII-EM and to correlate liquid and viscous bolus transit by impedance with esophageal contractions by manometry. METHODS: Forty-three normal volunteers recruited from 4 centers (15 women, 28 men; age range, 21-72 years) underwent combined MII-EM with a catheter containing 4 impedance-measuring segments and 4 solid-state pressure transducers. Each center recruited and analyzed subjects independently, according to pre-established criteria. Each subject received 20 x 5 mL swallows, 10 liquid and 10 viscous material. Tracings were analyzed manually for bolus presence time, bolus head advance time, segmental transit times, total bolus transit time, contraction amplitude, duration, and onset velocity. RESULTS: Ninety-seven and four-tenths percent of manometrically normal liquid and 96.1% of manometrically normal viscous swallows had complete bolus transit by impedance. Almost half (47.2%) of manometrically ineffective liquid and 34.7% of ineffective viscous swallows had complete bolus transit, whereas 91.7% of manometric simultaneous liquid swallows and 54.5% of simultaneous viscous swallows had complete bolus transit. More than 93% of normal individuals had at least 80% complete liquid or at least 70% complete viscous bolus transit. CONCLUSIONS: This study establishes normative data for combined MII-EM. Combined MII-EM may be a more sensitive tool in assessing esophageal function compared to standard manometry because impedance can distinguish different bolus transit patterns. Studies in patients with manometrically defined esophageal motility abnormalities should help clarify the functional importance of manometric ineffective and simultaneous swallows.     

Esophageal solid bolus transit: studies using combined multichannel intraluminal impedance and manometry in healthy volunteers

The purpose of this study is to apply combined multichannel intraluminal impedance and esophageal manometry (MII‐EM) to test esophageal function during solid swallowing in a normal healthy population. We determined whether combined MII‐EM with solid bolus is more sensitive than that with viscous bolus in the detection of motility abnormality. Eighteen healthy volunteers (11 men and 7 women; mean age 22 years, range 20–26 years) underwent combined MII‐EM with a catheter containing four impedance‐measuring segments and five solid‐state pressure transducers. Each subject received 10 viscous and 10 solid materials. Tracings were analyzed manually for bolus presence time, total bolus transit time, contraction amplitude, duration, and onset velocity. Three hundred and sixty swallows including viscous and solid materials were analyzed. Contraction amplitude for the viscous swallows was higher at 20 cm above the lower esophageal sphincter (LES) (P= 0.049) but lower at 15 cm above the LES (P < 0.001). Duration of contractions for the solid swallows was longer at 15 cm (P= 0.002) and 10 cm above the LES (P= 0.011) compared with viscous swallows. The total bolus transit time for solid was significantly shorter than that for viscous boluses (6.8 vs. 7.7 seconds, P < 0.001). Bolus presence time appeared to be similar between viscous and solid boluses (except in the proximal esophagus). The percentage of swallows with ineffective peristalsis by manometry, as well as those with incomplete bolus transit by impedance, did not differ between viscous and solid swallows. The proportion of manometrically ineffective solid swallows with incomplete bolus transit was greater than that of viscous swallows (62.1% vs. 34.8%, P= 0.05). Application of solid boluses may potentially enhance diagnostic capability of esophageal function testing. Solid boluses can be regarded as a valuable complement to viscous boluses in the detection of esophageal motility abnormalities when applied with combined MII‐EM.     

Assessment of esophageal motor function using combined multichannel intraluminal impedance and manometry in healthy volunteers: a single-center study in Taiwan

BACKGROUND: Combined multichannel intraluminal impedance and manometry (MII-EM) allow simultaneous measurement of both pressure and bolus transit. The aim of this study was to establish normative data in Chinese subjects for combined MII-EM and to correlate liquid and viscous bolus transit by impedance with esophageal contractions by manometry. METHODS: Eighteen normal volunteers (six women and 12 men; mean age 24 years, range 19-36 years) underwent combined MII-EM with a catheter containing four impedance-measuring segments and five solid-state pressure transducers. Each subject received 10 liquid and 10 viscous material swallows of 5 mL each. Tracings were analyzed for bolus presence time, total bolus transit time, contraction amplitude, duration, and onset velocity. RESULTS: A total of 180 liquid and viscous swallow responses were analyzed. In all, 98.4% percent of manometrically normal liquid and 97.7% of manometrically normal viscous swallows had complete bolus transit by impedance. More than half (56.3%) of manometrically ineffective liquid and 50% of ineffective viscous swallows had complete bolus transit. Nearly 90% of normal individuals had at least 70% complete liquid bolus transit while more than 90% of normal individuals had at least 70% complete viscous bolus transit. CONCLUSIONS: This study establishes normative data for combined MII-EM in a healthy Chinese population. These data will help provide impedance application in esophageal function testing with a reference range that could be utilized by future studies or clinical practices involving Chinese subjects.     

Symptom and function heterogenicity among patients with distal esophageal spasm: studies using combined impedance-manometry

BACKGROUND: Combined multichannel intraluminal impedance and esophageal manometry (MII-EM) is a clinically available tool that assesses the functional defect of various manometric abnormalities. The aim of our study was to evaluate esophageal bolus transit in patients with manometrically defined distal esophageal spasm (DES). METHODS: Patients referred for esophageal function testing underwent combined MII-EM studies including 10 liquid and 10 viscous swallows. Individual swallows were classified using previously published manometric and impedance criteria. DES is traditionally defined as > or =20% simultaneous contractions in the distal esophagus. Diagnosis of esophageal transit abnormalities was defined by the presence of > or =30% incomplete liquid or > or =40% incomplete viscous swallows. RESULTS: Data from 71 patients (43 female, mean age 57 yr, range 16-85) with a manometric diagnosis of DES were analyzed. During liquid swallows, patients with chest pain had higher (p < 0.05) distal esophageal amplitudes (202.3 +/- 34.5 mmHg) and a higher (p < 0.05) percentage of swallows with complete bolus transit (89%+/- 3%) compared to patients presenting with dysphagia (amplitude 117.8 +/- 8.7 mmHg; percentage of complete transit 69%+/- 5%) and patients with reflux symptoms (amplitude 116.4 +/- 12.7 mmHg; percentage of complete transit 74%+/- 5%). Fifty-one percent of the DES patients had a normal bolus transit for liquid and viscous, 24% abnormal bolus transit for one substance, and 25% abnormal bolus transit for liquid and viscous. CONCLUSION: Pressure and bolus transit information in patients with manometrically defined DES points toward heterogenicity of this group of patients. Outcomes data are warranted to evaluate whether stratifying DES patients based on pressure and bolus transit information may improve the clinical approach.     

Combined multichannel intraluminal impedance and manometry clarifies esophageal function abnormalities: study in 350 patients

BACKGROUND: Combined multichannel intraluminal impedance and esophageal manometry (MII-EM) is a technique that uses an FDA-approved device allowing simultaneous evaluation of bolus transit (MII) in relation to pressure changes (EM). METHODS: During a 9-month period, beginning from July 2002 through March 2003, we prospectively performed combined MII-EM on all patients referred for esophageal function testing. Each patient received 10 liquid and 10 viscous swallows. Manometric findings were reported based on criteria described by Spechler and Castell for liquid swallows. MII findings were reported as having normal bolus transit if >/=80% (8/10) of liquid and >/=70% (7/10) of viscous swallows had complete bolus transit. RESULTS: Three-hundred fifty studies were evaluated from patients with a variety of symptoms having the following manometric diagnoses: normal manometry (125), achalasia (24), scleroderma (4), ineffective esophageal motility (IEM) (71), distal esophageal spasm (DES) (33), nutcracker esophagus (30), hypertensive lower esophageal sphincter (LES) (25), hypotensive LES (5), and poorly relaxing LES (33). None of the patients with achalasia and scleroderma had normal bolus transit. Fifty-one percent of patients with IEM and 55% of patients with DES had normal bolus transit while almost all (more than 95%) patients with normal esophageal manometry, nutcracker esophagus, poorly relaxing LES, hypertensive LES, and hypotensive LES had normal bolus transit. Dysphagia occurred most often in patients with incomplete bolus transit on MII testing. CONCLUSION: Esophageal body pressures primarily determine bolus transit with isolated LES abnormalities appearing to have little effect on esophageal function. MII clarifies functional abnormalities in patients with abnormal manometric studies.     

Normal values for manometry performed with swallows of viscous test material

OBJECTIVE: Esophageal function testing with combined multichannel intraluminal impedance and manometry (MII-EM) is performed using ten 5-ml liquid and viscous swallows. Diagnosis of bolus transit abnormalities identified by impedance is based on both liquid and viscous swallows. Manometric diagnosis is based solely on liquid swallows. The aim of this study was to establish the normal values for manometry performed with a viscous bolus. MATERIAL AND METHODS: MII-EM studies performed in 80 healthy volunteers were analyzed. The analyzed manometric parameters included contraction amplitude and duration, distal onset velocity and lower esophageal sphincter (LES) residual pressure. RESULTS: Mean distal esophageal amplitude (DEA) (mmHg) for liquid swallows was 104 (+/-44) and for viscous swallows 102 (+/-51). Viscous versus liquid swallows were characterized by higher contraction amplitudes at 10 cm above the LES, slower distal onset velocities and higher LES residual pressures. Duration of contractions was similar between liquid and viscous swallows. Upper normal limits for viscous swallows were: 204 mmHg for DEA (mean+/-2 SDs); 6 ineffective and 1 simultaneous swallows and 11.7 mmHg for LES residual pressure (95th percentile). CONCLUSIONS: Based on our results, the following values should be considered normal for manometry performed with viscous swallows: 相似文献   

Clarification of the esophageal function defect in patients with manometric ineffective esophageal motility: studies using combined impedance-manometry.

BACKGROUND & AIMS: Combined multichannel intraluminal impedance (MII) and manometry (MII-EM) recently became available as an esophageal function test. Initial studies in healthy volunteers have shown that a proportion of ineffective contractions actually have complete bolus transit. The aim of our study is to evaluate esophageal bolus transit in patients with manometric patterns of ineffective esophageal motility (IEM). METHODS: All patients referred for esophageal function testing during a 9-month period underwent combined MII-EM studies, including 10 liquid and 10 viscous swallows. IEM is defined as >or=30% liquid swallows with contraction amplitude <30 mm Hg in the distal esophagus. Diagnosis of esophageal transit abnormalities is defined as abnormal bolus transit if >or=30% of liquid and >or=40% of viscous swallows had incomplete bolus transit. RESULTS: Seventy patients (35 women; mean age, 54 yr; range, 17-86 yr) with a manometric diagnosis of IEM were identified of a total of 350 combined MII-EM studies. In these patients, 68% of liquid and 59% of viscous swallows showed normal bolus transit, and almost one third of patients received an overall diagnosis of normal bolus transit for both liquid and viscous swallows. CONCLUSIONS: Our experience with combined MII-EM in patients with a manometric diagnosis of IEM confirms the suspicion that "effectiveness" should only be determined by using a test of esophageal function. Furthermore, we believe our results support a conclusion that a higher level of esophageal diagnostic information is best obtained by combined MII-EM. Future outcome studies should establish its value in patients with nonobstructive dysphagia and in prefundoplication assessment.     

Effect of buspirone, a 5-HT1A receptor agonist, on esophageal motility in healthy volunteers

There are limited data concerning the effects of 5-HT(1A) receptor activation on esophageal motility. Sumatriptan, a 5-HT(1A) receptor agonist, was recently reported to enhance esophageal peristalsis after intravenous administration. Buspirone, an orally available 5-HT(1A) receptor agonist, was shown to modulate gastroduodenal motor function. Our aim was to evaluate the effect of buspirone on esophageal motility of healthy volunteers. On two separate visits, 20 healthy volunteers aged 21-29 years (nine women) underwent esophageal manometry before and 10, 30, and 60 minutes after the administration of buspirone 20-mg or placebo capsule, according to a double-blind crossover design. At each time point, we compared buspirone and placebo effects on: resting pressure of the lower esophageal sphincter (LES); residual pressure and duration of LES relaxation; amplitude, duration, and onset velocity of esophageal body contractions, during 10 swallows of 5 mL of water. Significant analysis of variance differences (P < 0.05) are presented as mean ± standard deviation. Buspirone significantly increased mean distal esophageal wave amplitude (151 vs. 87 mmHg, P < 0.05) and duration (6.1 vs. 4.2 seconds, P < 0.05). Similarly, buspirone significantly increased mean LES resting pressure (26 vs. 21 mmHg, P < 0.05) and mean residual LES pressure (7.9 vs. 2 mmHg, P < 0.05), whereas reduced mean LES relaxation duration (7.2 vs. 8.0 seconds, P < 0.05) and mean distal onset velocity (7.6 vs. 14.7 cm/second, P < 0.05). Buspirone enhances esophageal peristalsis and LES function in healthy volunteers. Further study is warranted on the effects of buspirone on esophageal function and symptoms in patients with ineffective esophageal motility.     

Pharyngeal clearance during swallowing: a combined manometric and videofluoroscopic study.

The deglutitive pharyngeal contraction was analyzed using simultaneous videofluoroscopic and manometric studies of eight volunteers. Anterior, posterior, and longitudinal movements of the pharyngeal surfaces, relative to the cervical vertebrae, were measured during swallows of 5 and 10 mL of liquid barium. Profound pharyngeal shortening during bolus transit through the pharynx eliminated access to the larynx and elevated the upper esophageal sphincter to within 1.5 cm of the retrolingual pharynx. Bolus head movement through the pharynx preceded the propagated pharyngeal contraction and registered manometrically as a slight intrabolus pressure before the major pressure complex. Contraction in the horizontal plane began after bolus head transit and culminated with stripping of the bolus tail through the pharynx. Prolonged upper sphincter opening with the larger-volume swallows resulted from a delayed onset rather than altered propagation of the horizontal pharyngeal contraction. It is concluded that the propagated pharyngeal contraction facilitates pharyngeal clearance but has a minimal role in the process of bolus propulsion during swallowing. The propagated contraction works in concert with profound pharyngeal shortening to minimize hypopharyngeal residue after a swallow.     

Relationship between bolus transit and LES-relaxation studied with concurrent impedance and manometry

BACKGROUND/AIMS: Neuromuscular mechanisms regulating esophageal bolus transport are well studied. However, detailed data about the relationship between bolus transit and lower esophageal sphincter (LES)-relaxation during conventional motility testing are still lacking. METHODOLOGY: We performed systematic studies in 25 normal subjects, employing a catheter that integrates the two techniques impedancometry and manometry in a single instrument for simultaneous recording and analysis of the relationship between bolus transit and LES relaxation after swallowing saline or yogurt. RESULTS: 195 swallows were analyzed. LES relaxation occurred frequently later than UES relaxation. The mean latency between bolus entry into the esophagus and LES relaxation was 3.6 +0.2 sec. Two types of swallow-induced LES relaxation were observed: (a) LES relaxation preceding bolus transit (46 cases or 24%) and (b) LES relaxation occurring during bolus transit (149 cases or 76%). In the later case, during 114 (76%) cases of this deglutition, the position of the bolus was very close to the LES. CONCLUSIONS: During deglutition, LES relaxation seems to be modulated by bolus transit and occurs predominantly upon arrival of the bolus in the distal esophagus.     

Identification and mechanism of delayed esophageal acid clearance in subjects with hiatus hernia

To determine if hiatus hernia (HH) contributes to the delayed clearance of acid from the esophagus in patients with gastroesophageal reflux (GER), we performed simultaneous esophageal pH recordings and radionuclide studies in three study populations: 12 GER patients with HH, 5 GER patients with no HH, and 8 subjects with HH but no GER symptoms. Acid clearance was measured at 5 cm. above the manometrically located lower esophageal sphincter (LES) after injecting a 15-ml. bolus of 0.1 N HCl at 15 cm. above the LES. The acid was labeled with 200 mu Ci of 99mTc-sulfur colloid. Acid clearance was also measured at 10 cm. above the LES after injection of a 15-ml. bolus of 0.1 N HCl at 20 cm. above the LES. Acid clearance at 5 cm. above the LES was faster in GER patients with no HH compared to GER patients with HH and asymptomatic HH subjects. Acid clearance was faster at 10 cm. than 5 cm. above the LES in all HH and non-HH subjects studied. In non-HH subjects, each swallow resulted in an increase in pH (a monophasic pH response) at 5 and 10 cm. above the LES. In symptomatic as well as asymptomatic HH subjects, swallows resulted in an initial fall followed by a rise in pH at 5 cm. above the LES (a biphasic pH response). Radionuclide studies showed reflux of the isotope-labeled acid into the esophagus followed by clearance (a biphasic response) accompanying swallows in 15 of the 20 HH subjects. Swallow-induced reflux was not detected by radionuclide scanning in non-HH subjects. Based on these observations, we conclude that during acid clearance a small amount of acid is trapped in the HH sac and refluxes into the esophagus during subsequent swallows when there is relaxation of the LES, and these repeated episodes of acid reflux from the HH account for the delayed acid clearance observed in GER patients with HH.     

Revised criterion for diagnosis of ineffective esophageal motility is associated with more frequent dysphagia and greater bolus transit abnormalities

BACKGROUND: Ineffective esophageal motility (IEM) has been defined by the presence of > or = 30% liquid swallows with contraction amplitude < 30 mmHg (ineffective swallows) in the distal esophagus ("old" IEM). A recent study with combined multichannel intraluminal impedance and manometry (MII-EM) raised the question whether the manometric diagnosis of IEM should be based on a new definition: > or = 50% ineffective liquid swallows ("new" IEM). The aim of this study was to evaluate the association between the number of ineffective liquid swallows and symptoms and bolus transit in patients with "new" or "old" IEM who underwent MII-EM studies using 10 liquid and 10 viscous swallows. MATERIALS AND METHODS: There were 150 patients with "old" IEM included in the study. The patients diagnosed with "old" IEM (N = 150) (group A) were compared with those who retained a manometric diagnosis of IEM by the new definition (N = 101) (group B). The patients who did not retain their manometric diagnosis of IEM by the new definition (N = 49) (group C) were compared with group B. IEM was characterized as mild (normal bolus transit for both liquid and viscous swallows), moderate (abnormal bolus transit either for liquid or viscous swallows), or severe (abnormal bolus transit for both liquid and viscous swallows). RESULTS: There was no statistical difference in frequency of mild, moderate, or severe IEM and frequency of symptoms between group A and B. Group C had a significantly higher frequency of mild IEM and significantly lower frequency of severe IEM than group B. Heartburn (25.7%vs 10.2%, P= 0.03) and dysphagia (24.8%vs 12.3%, P= 0.08) showed a trend towards a greater frequency in group B than in group C. CONCLUSION: Our study indicates that IEM with > or = 50% ineffective liquid swallows is frequently associated with bolus transit abnormalities and esophageal symptoms. Our results underscore the rationale for using the new definition of IEM.     

Impaired Esophageal Bolus Transit in Patients with Gastroesophageal Reflux Disease and Abnormal Esophageal Acid Exposure

Background/Aims

We assessed the bolus transit and motility characteristics in gastroesophageal reflux disease (GERD) patients with abnormal esophageal pH monitoring.

Methods

We retrospectively reviewed the combined impedance-esophageal manometry data from consecutive patients who had abnormal acid exposure during 24-hour esophageal pH monitoring. We compared these data to the results from functional heartburn (FH) and asymptomatic volunteers.

Results

The data from 33 GERD patients (mean age of 51 years, 18 males), 14 FH patients (mean age of 51 years, one male), and 20 asymptomatic volunteers (mean age of 27 years, nine males) were analyzed. Ineffective esophageal motility was diagnosed in 10% of the volunteers, 21% of the FH patients, and 15% of the GERD patients. Ineffective contraction was more frequent in GERD and FH patients than in volunteers (16% and 20% vs 6%, respectively; p<0.05). Additionally, 10% of the volunteers, 21% of the FH patients and 36% of the GERD patients had an abnormal bolus transit. Complete bolus transit was less frequent, and bolus transit was slower in GERD patients than in volunteers for liquid (70% vs 85%) and viscous swallows (57% vs 73%). A longer acid clearance time was associated with abnormal bolus transit in the GERD group.

Conclusions

Patients with GERD have mild peristaltic dysfunction and incomplete and slower esophageal bolus transit. These conditions predispose them to prolonged acid contact with the esophagus.     

Esophageal Motility of Patients with Chagas' Disease and Idiopathic Achalasia

Chagas' disease and idiopathic achalasia have the same neuropathic lesion—the loss of ganglion cells within the esophageal myenteric plexus—with similar clinical, radiologic, and manometric features. However, it is suggested that there are some differences between them. We studied the esophageal motility of 45 patients with Chagas' disease (seven with esophageal dilation), 27 patients with idiopathic achalasia (13 with esophageal dilation), and 40 asymptomatic volunteers. We used the manometric method with continuous perfusion. The lower esophageal sphincter (LES) pressure was measured by the rapid pull-through method. Esophageal contractions was evaluated at 5, 10, and 15 cm above the LES, after 10 swallows of a 5-ml bolus of water alternated with 10 dry swallows. LES pressure was higher in achalasia than in Chagas' disease patients and controls (P < 0.05). Amplitude of contraction was lower in all patient groups compared with controls (P < 0.01) and lower in patients with dilation compared with patients without dilation (P < 0.05). The contraction duration was longer in patients with achalasia than in patients with Chagas' disease and controls (P < 0.05). The percentage of failed contractions was higher in Chagas' disease than in achalasia and controls (P < 0.05), and the percentage of simultaneous contractions was higher in patients with idiopathic achalasia than in patients with Chagas' disease and controls (P < 0.05). The results suggest the possibility that the extent of impairment of esophageal innervation differs between Chagas' disease and idiopathic achalasia.     

Esophageal contractions and oropharyngeal and esophageal transits in patients with iron deficiency anemia

OBJECTIVE: Patients with iron deficiency may have reduced power of the pharyngeal muscle for bolus propulsion into the esophagus. We hypothesized that esophageal muscle is similarly impaired. METHODS: We studied the oropharyngeal and esophageal transits and esophageal motility of 12 patients (11 women) aged 31-50 yr (median 36 yr) with iron deficiency anemia (serum iron less than 40 microg/dl) and 17 normal volunteers (16 women) aged 26-52 yr (median 37 yr) with serum iron greater than 60 microg/dl. The esophageal motility was studied by the manometric method, with continuous perfusion and 10 swallows of a 2-ml bolus of water alternated with 10 swallows of a 7-ml bolus; and the oropharyngeal and esophageal transits were studied by scintigraphy, with swallows of a 10-ml bolus for the study of oropharyngeal transit and of a 10-ml bolus for the study of esophageal transit. Motility and transit were studied in the supine position. RESULTS: The amplitude, duration and area under the curve of contractions were lower in patients than in volunteers. There were no differences in peristaltic contraction velocity, lower esophageal sphincter pressure, and lower esophageal sphincter relaxation duration. There was no difference in oropharyngeal transit. In the esophagus the transit was slower in patients than in volunteers. The time needed by the scintigraphic activity to reach a peak in the proximal esophagus was longer in patients than in volunteers. CONCLUSIONS: Iron deficiency may decrease esophageal contractions and impair esophageal transit.     

Sequential swallows have no influence on esophageal contractions of patients with iron deficiency anemia

BACKGROUND: An experimental study showed that thyropharyngeal, cricopharyngeal and cervical esophageal muscles of rabbits with iron deficiency anemia had morphological changes similar to those observed in muscular dystrophy, causing myastenic changes in muscles involved in swallowing. Our hypothesis is that patients with iron deficiency anemia may have a decrease in esophageal contractions with successive swallows. PATIENTS AND METHOD: We studied the esophageal motility of 12 women with iron deficiency anemia aged 31 to 50 years (median 36 years) with serum iron from 11 to 40 mug/dL (median 21 mug/dL), and 13 asymptomatic women aged 26 to 49 years (median 35 years) with serum iron over 60 mug/dL. We used the manometric method with continuous perfusion. The esophageal contractions were measured at 3, 9 and 15 cm from the upper margin of a sleeve that straddled the lower esophageal sphincter. Each subject performed 10 swallows of a 2 mL bolus of water alternated with 10 swallows of a 7 mL bolus, with an interval of 30 seconds between swallows. We measured the amplitude, duration, velocity and area under the curve of contractions. RESULTS: There was no difference between the swallows of a 2 mL or 7 mL bolus. The amplitude, duration and area under the curve were lower in patients with iron deficiency than in asymptomatic volunteers, mainly in the proximal and middle esophageal body. There was no difference in velocity. Sequential swallows did not change contraction amplitude, duration, velocity or area under curve in patients and volunteers. CONCLUSION: Although the power of esophageal contractions was decreased in patients with iron deficiency anemia, sequential swallows did not cause further impairment.     

Effect of bolus taste on the esophageal transit of patients with stroke

Stroke is a frequent cause of oropharyngeal dysphagia but may also cause alterations in esophageal motility. The aim of this investigation was to evaluate the effect of bolus taste on the esophageal transit of patients with stroke and controls. Esophageal transit and clearance were evaluated by scintigraphy in 36 patients in the chronic phase of stroke (44–82 years, mean: 63 years) and in 30 controls (33–85 years, mean: 59 years). The patients had a stroke 1–84 months (median: 5.5 months) before the evaluation of esophageal transit. Eight had dysphagia. Each subject swallowed in random order and in the sitting position 5 mL of liquid boluses with bitter (pH 6.0), sour (pH 3.0), sweet (pH 6.9), and neutral (pH 6.8) taste. Transit and clearance duration and the amount of residues were measured in the proximal, middle, and distal esophageal body. There was no difference between patients and controls in esophageal transit or clearance duration. In the distal esophagus, the transit and clearance durations were longer with the sour bolus than with the other boluses in both patients and controls. The amount of residues in the esophageal body was greater in patients than in controls after swallows of the neutral bolus. In control subjects, after swallows of a sour bolus, there was an increase in the amount of residues in the middle and distal esophagus compared with the other boluses. In conclusion, a sour bolus with low pH causes a longer transit and clearance duration in the distal esophageal body. There was no effect of bolus taste or pH on the esophageal transit of patients in the chronic phase of stroke compared with normal volunteers. The longer transit and clearance duration in the distal esophageal body with the sour bolus appears to be a consequence of the low pH of the bolus.     

Evaluation of esophageal function in patients with esophageal motor abnormalities using multichannel intraluminal impedance esophageal manometry

INTRODUCTION Esophageal manometry has been considered the “gold standard” test for the evaluation of esophageal motility. Esophageal manometry allows physicians to assess peri- stalsis by using informations about the shape, amplitude and duration of the…     

Gastroesophageal pH step-up inaccurately locates proximal border of lower esophageal sphincter

Limiting the widespread use of 24-hr pH monitoring is the necessity of manometrically placing the pH probe 5 cm above the proximal lower esophageal sphincter (LES) border. Therefore, we prospectively compared LES localization by gastroesophageal pH step-up with manometry in 71 patients and 14 asymptomatic volunteers. The gastroesophageal pH step-up significantly correlated with the proximal LES border in patients (r=0.53, P<0.0001) and volunteers (r=0.91, P<0.0001). Based on previously published criteria, the pH step-up value was considered acceptably accurate if it was within ±3 cm (6 cm total span) of the manometrically determined proximal LES border. In 58% of patients and 29% of volunteers the pH step-up occurred outside this accuracy range. Esophagitis (P=0.015) and abnormal reflux parameters (P=0.002) were variables contributing to this error. Subsequent analysis found that the pH step-up overestimated the proximal LES border and occurred at the midportion of the sphincter. The pH step-up still inaccurately located the mid LES in 34% of patients. Therefore, manometry should remain the standard for accurate LES localization prior to placing the pH probe.     

Videofluoroscopic Evaluation of Swallowing in Chagas�� Disease

Dysphagia is the most common digestive symptom reported by patients with Chagas’ disease. The condition results from abnormalities of esophageal motility. Our hypothesis is that there are also alterations of oral and pharyngeal transit during swallowing. We studied by videofluoroscopy the oral and pharyngeal transit during swallowing in 17 patients with dysphagia, a positive serologic test for Chagas’ disease, and radiologic demonstration of esophageal involvement. The study also included 15 asymptomatic healthy volunteers. Each subject swallowed in duplicate 5 and 10 ml of liquid and paste barium boluses. Chagas’ disease patients had a longer oropharyngeal transit with the 5-ml liquid bolus (p = 0.03), and a longer oral transit (p = 0.01) and pharyngeal transit (p = 0.04) with the 10-ml liquid bolus than controls. There was no difference between patients and controls with swallows of the 5-ml paste bolus. With swallows of the 10-ml paste bolus, the oropharyngeal transit (p = 0.05), pharyngeal transit (p = 0.04), pharyngeal clearance (p = 0.02), and UES opening (p = 0.01) took a longer amount of time in Chagas’ disease patients than in controls. We conclude that the duration of pharyngeal transit is longer in patients with Chagas’ disease than in normal subjects, especially with a bolus of pasty consistency and a volume of 10 ml.