Upper esophageal sphincter pressure recording: is an oval manometry catheter necessary?
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
J A Castell
Publications and source records attributed to J A Castell.
On-line computer analysis of human lower esophageal sphincter relaxation.
Lower esophageal sphincter (LES) relaxation is usually interpreted by a subjective, mostly qualitative analysis. We studied sphincter relaxation in humans using a computer program for on-line analysis that provides objective measures of gastric pressure, resting LES pressure, percent of relaxation, residual pressure during relaxation, duration of relaxation, and area of relaxation. The program was validated by comparing computer-analyzed values to mean values obtained from manual readings by five individuals. Excellent correlation was obtained for all standard parameters. The parameters of LES relaxation for both wet and dry swallows were similar using either a carefully placed single recording orifice or a Dent sleeve. The one exception was the duration of LES relaxation, which was significantly shorter with the sleeve. All relaxation parameters and peristaltic velocity were then studied in 10 volunteers during 5 dry and 5 wet swallows under base-line conditions and after both atropine (10 micrograms/kg iv) and bethanechol (40 micrograms/kg sc). These studies showed that LES relaxation is affected by type of swallow (dry vs. wet). Percent of relaxation may not be the best measure of relaxation because it is too dependent on resting pressure. Residual pressure is not dependent on base-line pressure and may better define relaxation. Duration of the relaxation is dependent on the velocity of the peristaltic wave.
Adult↗
Esophageal manometry in 95 healthy adult volunteers. Variability of pressures with age and frequency of "abnormal" contractions.
UNLABELLED: Although esophageal manometry is widely used in clinical practice, the normal range of esophageal contraction parameters is poorly defined. Therefore, 95 healthy volunteers (mean age: 43 years; range 22-79 years) were studied with a low-compliance infusion system and 4.5-mm-diameter catheter. All subjects were given 10 wet swallows (5 cc H2O) and 38 subjects also were given 10 dry swallows. RESULTS: Amplitude, but not duration, was greater (P less than 0.05) after wet compared to dry swallows. Both distal mean contractile amplitude and duration of wet swallows significantly increased with age and peaked in the fifties. Double-peaked waves frequently occurred after both wet (11.3%) and dry (18.1%) swallows, but triple-peaked waves were rare (less than 1%). Nonperistaltic contractions were more common (P less than 0.001) after dry compared to wet swallows (18.1% vs 4.1%). This difference resulted from frequent simultaneous contractions after dry swallows (12.6% vs 0.4%). CONCLUSIONS: Distal esophageal contractile amplitude and duration after wet swallows increases with age. Triple-peaked waves and wet-swallow-induced simultaneous contractions should suggest an esophageal motility disorder. Double-peaked waves are a common variant of normal. Dry swallows have little use in the current evaluation of esophageal peristalsis.
Adult↗
Computer analysis of human esophageal peristalsis and lower esophageal sphincter pressure. II. An interactive system for on-line data collection and analysis.
A computer program has been written to directly read and analyze esophageal manometric tracings on-line using low-cost off-the-shelf microcomputer hardware. The system consists of an Apple IIe microcomputer and an Interactive Microwave Inc. ADALAB Data Acquisition System with an AI13 fast A/D Multiplexer. The primary program is in BASIC with ASSEMBLY language subroutines for data collection. Data are collected through the voltage output of a Hewlett-Packard recorder at 30 points per second on four channels for lower esophageal sphincter pressures (LESP) and three channels for peristaltic waves. Computer-determined values for LESP and wave parameters showed excellent correlation with mean values as read by five individuals experienced in esophageal manometry.
Adult↗
Pirenzepine and propantheline effects on esophageal pressure responses to bethanechol.
Pirenzepine is an antisecretory anticholinergic type drug that has recently been shown to be relatively free of usual anticholinergic side effects on esophageal smooth muscle. It has also been suggested that this drug might release some of the inhibitory control of the esophagus and allow increased muscle contractions. To test this hypothesis, we compared the response of the lower esophageal sphincter (LES) and esophageal peristaltic contractions to bethanechol in 12 healthy controls after background oral doses of placebo, pirenzepine (50 mg), and propantheline (30 mg). After baseline placebo, bethanechol (40 micrograms/kg subcutaneously) produced the expected significant increases in LES pressure and amplitude of peristaltic contractions. Maximal increases were 51.9 +/- 14.9 and 29.5 +/- 7.0%, respectively. Also as expected, propantheline inhibited the cholinergic stimulation from bethanechol, allowing only a 10.1 +/- 13.6% increase in LES pressure and a decrease in peristaltic contraction amplitudes (-44.1 +/- 5.0%) after bethanechol. After background pirenzepine, the responses to bethanechol were intermediate between the other two drugs. A significant increase (44.2 +/- 16.4%) in LES pressure occurred after bethanechol while no significant changes (6.9 +/- 5.8%) were noted in peristaltic amplitudes with this drug. Typical side effects of dry mouth were noted in six of the 12 subjects with propantheline and in only three subjects after pirenzepine. These studies once again confirm the absence of usual anticholinergic side effects with oral pirenzepine compared to oral propantheline in the doses studied. We could find no evidence for a release of cholinergic inhibition after pirenzepine administration.
Adult↗
Solid-state computerized manometry improves diagnostic yield in pharyngeal dysphagia: simultaneous videoradiography and manometry in dysphagia patients with normal barium swallows.
OBJECTIVE: Dynamic barium radiology with cine- or video recording has been the most frequently used technique for assessing patients with pharyngeal dysphagia. Although the diagnostic yield of the barium swallow has been high, many patients with pharyngeal dysphagia have normal dynamic barium radiology and remain a diagnostic dilemma. Could manometry add important diagnostic information in these patients? MATERIAL AND METHODS: We examined 19 patients (12 men and 7 women, mean age 47 years, range 19-69 years) with pharyngeal dysphagia but a normal barium swallow with simultaneous videoradiography and pharyngeal manometry and compared their manometry to that found in 24 normal volunteers (11 men and 13 women, mean age 37 years, range 23-59 years). RESULTS: Comparing mean values, the patient group showed statistically significant differences from the control group for eight of 10 manometric parameters. Fourteen of 19 patients showed at least one (five patients) and in most cases multiple (nine patients) manometric abnormalities (values exceeding normal mean by +/- 2SD) which might have contributed to their dysphagia: five patients with high upper esophageal sphincter (UES) resting pressures, five with high UES residual pressures, three with weak pharyngeal contractions, three with pharyngeal "spasms," seven with prolonged contraction/relaxation times, five with reduced compliance, and seven with UES/P incoordination. CONCLUSIONS: Solid-state computerized manometry is a useful adjunct to videoradiography and can provide potentially important additional information in the diagnosis of dysphagia patients.
Adult↗
Pharyngeal and upper esophageal sphincter manometry in the evaluation of dysphagia.
The use of esophageal manometry seems to be increasing, but the utility of pharyngeal and upper esophageal sphincter (UES) manometry is not widely recognized. This article is intended to clarify this subject. Initially, we review the anatomy and physiology of this area. Most studies indicate that the manometry of the UES and pharynx provides useful information primarily in patients that have symptoms of oropharyngeal dysfunction. Oropharyngeal dysphagia has high morbidity, mortality, and cost. It occurs in one third of all stroke patients and is common in the chronic care setting; up to 60% of nursing home occupants have feeding difficulties, of whom a substantial portion have dysphagia. For patients with oropharyngeal dysphagia, as for those with esophageal dysphagia, barium swallow study and manometry are complimentary. Their combined use permits us to enhance the understanding of the pathophysiologic process that causes the patient's symptoms. Abnormalities have been noted in a variety of diseases, such as Parkinson's disease, oculopharyngeal muscular dystrophy, achalasia, and scleroderma. Thus, it is possible to determine the primary pathology that is causing the patient's dysphagia by analyzing the manometry results. Pharyngeal and UES manometry also has a value in evaluating patients who are candidates for myotomy or dilatation, as it can help identify patients with a prospective good outcome.
Deglutition Disorders↗