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Biomedical subjects

J A Castell

Publications and source records attributed to J A Castell.

At least 37 records · Page 2Linked to original sources
PubMed1995

Manometric characteristics of the pharynx, upper esophageal sphincter, esophagus, and lower esophageal sphincter in patients with oculopharyngeal muscular dystrophy.

Improved techniques in esophageal manometry have made this test an attractive option for investigating pharyngeal or esophageal disorders in patients with dysphagia. We studied esophageal as well as upper esophageal sphincter/pharyngeal (UES/P) pressure dynamics in 11 patients with an established diagnosis of oculopharyngeal muscular dystrophy with modern solid-state manometric techniques and then compared manometric and clinical findings. Esophageal manometric abnormalities were found in 10/11 patients, with the most common being simultaneous contractions and incomplete lower esophageal relaxation. 9/11 patients showed abnormal UES/P manometrics, with the most common abnormalities found in the pharynx. The presence of manometric abnormalities closely paralleled clinical assessment of degree of disease severity. Modern manometric techniques offer an opportunity for a quantitative assessment of swallow abnormalities.

Aged↗
PubMed1995

Swallowing and esophageal function in Parkinson's disease.

Dysphagia and drooling of saliva are frequent symptoms in Parkinson's disease (PD), occurring in one-half and three-quarters of all patients, respectively. Aspiration related to swallowing is a major cause of morbidity and mortality in PD. Defects in oral, pharyngeal, and esophageal phases of swallowing have been documented in patients with PD, and these defects precede symptoms. This paper reviews the current knowledge concerning swallowing abnormalities in PD. The pathogenesis of dysphagia and drooling of saliva is multifactorial, involving cognitive and psychological changes in addition to abnormalities of the extrapyramidal and autonomic nervous systems. Videofluoroscopic imaging of the upper esophageal sphincter and pharynx during mastication and swallowing has been the basis of our understanding of the mechanical malfunction present in patients with PD. Manometric abnormalities of the esophageal body and lower esophageal sphincter have also been documented. The use of combined manofluoroscopy to examine the upper esophageal sphincter and pharynx in PD offers great promise both in understanding the defects and directing therapy. Voluntary airway protection techniques may reduce aspiration, but they need to be tested in a clinical study. Such maneuvers may reduce the morbidity seen in PD.

Deglutition↗
PubMed1994

Frequency and site of gastroesophageal reflux in patients with chest symptoms. Studies using proximal and distal pH monitoring.

Prolonged ambulatory pH monitoring was performed on 89 patients with previous diagnosis of asthma (27 patients), chronic cough (28 patients), noncardiac chest pain (34 patients), and on 27 healthy control subjects. The extent of gastroesophageal reflux (GER) was determined using a catheter containing two antimony pH electrodes positioned 5 cm and 20 cm above the superior border of the manometrically determined lower esophageal sphincter. Reflux was defined as a drop in pH to < 4 in the distal esophagus. We compared both pH < 4 and pH < 5 as the beginning of reflux episodes for the proximal esophagus. Considering the confidence interval of 95% in healthy control subjects as a normality criterion, we found a prevalence of abnormal distal GER in 44% of asthmatics, 50% of patients with cough, and 53.8% of patients with noncardiac chest pain. Abnormal proximal acid exposure was found in 24% of asthmatics, 10.7% of patients with cough and 44.1% of patients with chest pain. Distal acid exposure was significantly longer than proximal esophageal acid exposure in all patient groups (p < 0.05). There were no differences in the evaluation of proximal GER comparing pH < 4 with pH < 5. The data also indicate a tendency toward upright, rather than supine acid exposure. These results support the use of 24-h pH monitoring in patients with chest complaints and indicate that GER may frequently be involved in the pathogenesis. They do not support the theory that proximal GER is a specific etiologic factor in chronic cough or asthma.

Asthma↗
PubMed1994

Approach to patients with oropharyngeal dysphagia.

Oropharyngeal dysphagia is a difficult clinical problem that is commonly found in patients with diffuse neurological or local laryngeal disorders. Gastroenterologists are frequently consulted regarding management of these patients. Diagnosis of specific pathophysiology is best accomplished with a combined approach, including barium video radiography and solid-state manometry. Therapy includes specific modalities where appropriate and mechanical manipulations aimed at prevention of aspiration, in consultation with a speech language pathologist.

Deglutition Disorders↗
PubMed1994

Manometric determination of esophageal length.

OBJECTIVE: Two hundred and fifty-two esophageal manometric studies were reviewed retrospectively to determine the length of esophagus and its relationship to disease, sex, height, and weight. METHODS: For all studies, solid state intraluminal transducers were used, with patients in the supine position. Esophageal length was defined as the difference between the high pressure zone of the upper esophageal sphincter and proximal margin of the lower esophageal sphincter. The mean length of the esophagus was 22.9 +/- 0.2 cm (+/- SEM) in all patients and volunteers (excluding those with achalasia). RESULTS: The 40 patients with achalasia had a significantly (p < 0.05) longer mean esophageal length (24.5 +/- 0.5 cm) than normal volunteers or other patient groups with scleroderma, GERD, chest pain, and dysphagia. Excluding patients with achalasia, 96 males had a significantly (p < 0.05) longer mean esophageal length (23.6 +/- 0.3 cm) than 116 females (22.4 +/- 0.3 cm). A normal distribution of esophageal length was demonstrated in all subjects (excluding those with achalasia). Esophageal length showed poor correlation with either height (r2 = 0.15) or body weight (r2 = 0.003). CONCLUSION: esophageal length showed considerable intersubject variation. Patients with achalasia had a longer esophagus consistent with esophageal dilation. Males had a longer esophagus than females. Esophageal length did not correlate with either height or weight.

Adolescent↗
PubMed1994

Manometric analysis of the pharyngo-esophageal segment.

Manometry of the pharyngo-esophageal segment can be a valuable tool in the investigation of pharyngeal dysphagia. Advances in technology have overcome previous equipment shortcomings and now allow accurate measurements of such factors as the rapid response rate of the striated muscle and asymmetry of the upper esophageal sphincter. Close attention to technique can overcome difficulties with movement artifacts encountered during deglutition. There are an increasing number of reports in the literature of manometric studies of normal swallow function as well as of patients with oropharyngeal dysphagia.

Deglutition Disorders↗
PubMed1993

Effect of head position on the dynamics of the upper esophageal sphincter and pharynx.

Due to limitations in available technology it has been difficult to obtain data on upper esophageal sphincter (UES) and pharyngeal (P) function under varying physiologic conditions. We used a manometry system with solid-state intraluminal transducers, including a circumferential sphincter transducer, and computer analysis to measure pressure changes in UES and P during wet (5 ml H2O) swallows as the head was moved through a 75 degree arc in nine normal volunteers. UES residual pressure increased markedly and duration of UES relaxation decreased with increasing head extension. Similar decreases were also seen with time between P peak and both UES nadir and UES end. There were no changes in either pharyngeal peak pressures or the duration of the pharyngeal contraction. Head extension produces major changes in UES relaxation and UES/P coordination. These effects may be clinically important when feeding neurologically impaired patients.

Adult↗
PubMed1993

Modern solid state computerized manometry of the pharyngoesophageal segment.

There has been renewed interest in the use of manometry of the pharyngoesophageal segment in the investigation of pharyngeal dysphagia. Advances in technology have alleviated previous difficulties presented by factors such as the rapid response rate of the striated muscle and asymmetry of the upper esophageal sphincter. Close attention to technique can overcome difficulties with movement artifacts encountered during deglutition. Manometry is being used to study normal swallow function and the effects of physiologic changes. There are also increasing numbers of reports in the literature of manometric studies in patients with oropharyngeal dysphagia. This technique provides information on pressure changes and augments that information obtained from a barium swallow.

Deglutition↗
PubMed1992

Alginic acid decreases postprandial upright gastroesophageal reflux. Comparison with equal-strength antacid.

This study tested the hypothesis that (alginic) acid may have a preferential effect on reflux in the upright position. We evaluated the effect of a compound containing alginic acid plus antacid (extra-strength Gaviscon) versus active control antacid with equal acid-neutralizing capacity on intraesophageal acid exposure following a high-fat meal (61% fat: sausage, egg, and biscuit). In random sequence, each of the 10 volunteers received either alginic acid-antacid or control antacid immediately following and 1, 2, and 3 hr after the meal. The sequence was repeated for both test drugs in the supine and upright positions with constant pH monitoring. Alginic acid-antacid significantly decreased postprandial reflux in the upright position compared to an equal amount of antacid. This effect did not occur in the supine position. These findings support the hypothesis that alginic acid is primarily effective in the upright position and the clinical observations of the effectiveness of alginic acid on daytime reflux symptoms.

Alginates↗
PubMed1992

Abnormal upper esophageal sphincter function in achalasia.

We describe the results of pharyngeal and upper esophageal sphincter (UES) manometry, using new solid-state computerized technology in 19 patients with achalasia, compared with 14 healthy controls. The major manometric finding in achalasia is an increased residual pressure in the UES. Other differences seen in patients with achalasia include a reduction in the duration of UES relaxation with swallowing and a more rapid onset of pharyngeal contraction after UES relaxation. We review previous descriptions of suspected pharyngeal and UES abnormalities in achalasia and compare them to our own.

Adult↗
PubMed1991

Radial and longitudinal asymmetry of human pharyngeal pressures during swallowing.

Radial asymmetry of upper esophageal sphincter resting pressure has been previously described; however, neither radial nor longitudinal asymmetry of pharyngeal pressures has been demonstrated. The authors used a specially designed intraluminal transducer catheter (Konigsberg; Konigsberg Instruments, Pasadena, CA) with four solid-state transducers separated by 3 cm and oriented circumferentially at 90 degrees intervals to measure pharyngeal pressures. Two wet swallows at each 1-cm interval along the length of the pharynx were measured in 12 normal volunteers (10 male, 2 female; mean age, 38 years). Pressure data were collected on-line by an Apple IIe microcomputer (Apple Computer Inc., Cupertino, CA) at 100 Hz and analyzed for both radial and longitudinal asymmetry. Significant (P less than 0.05) longitudinal asymmetry was shown in all positions except right lateral. Radial asymmetry was present for the first 4 cm only, with anterior and posterior pressures significantly (P less than 0.05) higher than lateral pressures. It was concluded that pharyngeal pressure responses show both axial and longitudinal asymmetry in the distal pharynx. Awareness of transducer position and orientation is essential in the evaluation of pharyngeal pressures.

Adult↗
PubMed1990

Comparison of effects of upright versus supine body position and liquid versus solid bolus on esophageal pressures in normal humans.

New studies monitoring ambulatory esophageal pressures during food ingestion often compare results to normal values obtained from supine liquid swallows. We compared distal esophageal peristaltic and lower esophageal sphincter (LES) pressures in 15 normal subjects during six liquid swallows in the upright and supine positions, and six solid (small marshmallow) swallows in upright position. LES pressures were significantly (P less than 0.05) higher supine than upright but no differences were noted in LES pressure, relaxation, and duration of relaxation between upright solid and liquid swallows. Distal peristaltic wave velocities were faster upright than supine. Peristaltic wave amplitudes, durations, and DP/DT were significantly (P less than 0.05) greater in supine than in upright position. Atypical wave forms, defined as nontransmitted, simultaneous, and simultaneous/repetitive, increased in the upright position compared to supine (P less than 0.01), and during solid vs liquid swallows (P less than 0.05). These results indicate that body position substantially affects normal distal esophageal peristalsis and LES pressure and that "abnormal" wave forms occur more frequently during swallowing solids than liquids in the upright position. Conclusions regarding "abnormal" motility over prolonged periods and during food ingestion in patients should be tempered by these findings.

Adult↗
PubMed1990

Pharyngeal/upper esophageal sphincter pressure dynamics in humans. Effects of pharmacologic agents and thermal stimulation.

Extensive physiological studies of swallowing have been carried out in laboratory animals; however, similar studies in humans have been limited by available technology. In this study we describe the use of a solid-state circumferential sphincter transducer to define manometric characteristics of the human pharynx and upper esophageal sphincter (UES). Effects of pharmacologic agents and thermal stimulation are also described. We studied nine normal volunteers on three separate days. All studies were done in the upright position and consisted of a station pull-through of the UES and six wet swallows with the sphincter transducer in the most proximal segment of the UES and a posteriorly oriented single transducer 5 cm proximal in the pharynx. Baseline studies preceded all drug studies. Effects of bethanechol were studied on day 1, cold stimulation and benzonatate on day 2, edrophonium and atropine on day 3. The UES resting pressure showed large intrasubject day-to-day variations; however, mean values did not differ. There were no effects on UES relaxation or swallow coordination with any of the pharmacologic agents, although benzonatate produced multiple pharyngeal contractions.

Adult↗
PubMed1990

Effects of body position and bolus consistency on the manometric parameters and coordination of the upper esophageal sphincter and pharynx.

The development of a solid-state intraluminal sphincter transducer has alleviated many of the problems associated with manometric studies of the upper esophageal sphincter (UES) and pharynx (P). We used this technology to study the effect of position (upright vs. supine) on resting UES pressures and the pressure dynamics of the UES/P complex during both wet and dry swallows in 11 normal volunteers and the effects of foods of different consistencies on the UES/P swallow dynamics in 10 normal volunteers. The UES/P coordination parameters were defined as the 15 time intervals that can be measured between any 2 of 6 pertinent points: the beginning, peak, and end of the pharyngeal contraction and the beginning, nadir, and end of the UES relaxation. Data from both the circumferential transducer used to measure sphincter pressures and a standard microtransducer used to measure pharyngeal pressures were collected on-line by an Apple IIe microcomputer and analyzed by programs written in our laboratory. Significant changes in swallow coordination were measured between upright and supine swallows of the same bolus size, between wet and dry swallows in the same position, and among foods of varying consistencies. Resting UES pressure was unchanged by position and pharyngeal contraction pressure was unchanged by bolus size or consistency.

Adult↗
PubMed1990

Pharyngeal and upper esophageal sphincter manometry in humans.

Manometric studies of pharyngeal-upper esophageal sphincter (UES) coordination during swallowing have proven difficult. Asymmetry of the UES makes pressure measurements with a single, unoriented transducer suspect. Perfused systems lack the necessary response rate for measuring peak pharyngeal contraction pressures. Precise quantification of the coordination of pharyngeal contractions and UES relaxations during swallowing is difficult because of rapid pressure changes. We tested a modified solid-state transducer that measures pressures over 360 degrees. This transducer was placed in the proximal UES with a second, single transducer 5 cm proximal. Data were collected and analyzed with an Apple IIe microcomputer. A computer program was developed to measure nine timing sequences, UES resting pressure, nadir of UES relaxation, and pharyngeal contraction pressures. We studied 21 volunteers with six swallows each for dry, 5, 10, and 20 ml of water. Dry swallows differed significantly (P less than 0.05) from wet (5 ml). All timing sequences became progressively longer with increasing bolus size. Residual pressures were unchanged. Timing sequences were also measured for wet (5 ml) and dry swallows in seven volunteers using a Dent sleeve and single perfused orifice in the UES; no differences were seen.

Adult↗
PubMed1990

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.

Adult↗
PubMed1989

Hypertensive lower esophageal sphincter: what does it mean?

The hypertensive lower esophageal sphincter (LES) (mean LES pressure greater than 45 mm Hg; LES relaxation greater than 75%; normal peristalsis) is a poorly characterized motility disorder associated with chest pain and dysphagia. Therefore, we carried out a multidisciplinary study to assess esophageal pressures and function in 15 symptomatic hypertensive LES patients (3 men, 12 women; mean age, 53 years). On-line computer analysis showed a significant (p less than 0.05) increase in LES pressure (55.5 versus 14.9 mm Hg) and residual pressure (6.8 versus 1.1 mm Hg) as well as a decrease in percentage of LES relaxation (87 versus 93%) in patients compared with age-matched controls. All patients had normal peristalsis but 7 of 15 had nutcracker esophagus (mean distal amplitude, 216 mm Hg). No patient had evidence of impaired liquid transport on barium esophagram. The emptying of solids as assessed by radionuclide scans was normal in 14 of 15 patients. Of the 12 patients who completed both psychological inventories, nine had elevated scores on scales assessing anxiety and somatization. The heterogenous nature of this disorder is illustrated by a patient with a changeable narrowing in the distal esophagus associated with the transient impaction of a marshmallow. Dysphagia but not chest pain improved after pneumatic dilatation. We conclude that the hypertensive LES is a heterogenous disorder. Despite abnormal LES parameters, most patients have normal esophageal function, and frequent psychological abnormalities may contribute to their report of symptoms. A minority have abnormal esophageal transit.

Adult↗