Abnormal elevation of resting pressure at the upper esophageal sphincter of Parkinson's disease patients

Effect of aging, bolus volume, temperature, and consistency on the pharyngeal peristalsis, as well as the effect of aging on the upper esophageal sphincter (UES) resting pressure and its response to esophageal distension by air and balloon, were studied in 14 young and 12 healthy elderly volunteers. In both age groups there was no significant volume or temperature effect on amplitude, duration, or velocity of the pharyngeal peristalsis. Compared with water swallows, mashed potato swallows resulted in a significant increase in the amplitude and duration of the hypopharyngeal peristaltic pressure wave (P < 0.05). For water swallows, the amplitude and duration of the peristaltic pressure wave in the hypopharynx were significantly increased in the elderly compared with the young group (P < 0.01). UES resting pressure in the elderly measured 43 +/- 5 (SE) mmHg and was significantly less than that of the young (71 +/- 8 mmHg; P < 0.01). Magnitude of the UES pressure decrease because of esophageal distension by air, as well as magnitude of its pressure increase because of esophageal balloon distension, was similar among young and elderly. 1) Contrary to common expectations, the parameters of the pharyngeal peristaltic pressure wave do not deteriorate in the elderly in their seventh and eighth decade. 2) Compared with the young, hypopharyngeal pressure wave amplitude and duration are significantly increased in the elderly. This increase could be caused by an adaptation response to a pharyngeal outflow compromise. 3) Pharyngeal peristaltic pressure wave amplitude and duration, but not its velocity, are modulated by the bolus consistency. This modulatory mechanism is preserved in the elderly. 4) Although UES resting pressure is significantly decreased in the elderly, its pressure response to esophageal distension by air and balloon is preserved.

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Effects of Head Rotation on Pharyngeal Function during Normal Swallow

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949810700414 ◽

1998 ◽

Vol 107 (4) ◽

pp. 344-348 ◽

Cited By ~ 55

Author(s):

Yukio Ohmae ◽

Masami Ogura ◽

Satoshi Kitahara ◽

Takehiro Karaho ◽

Tetsuzo Inouye

Keyword(s):

Healthy Subjects ◽

Head Rotation ◽

Normal Subjects ◽

Upper Esophageal Sphincter ◽

Resting Pressure ◽

Esophageal Sphincter ◽

Pharyngeal Clearance ◽

Pharyngeal Swallowing ◽

Peak Pressures ◽

Pharyngeal Function

This study quantified the effects of head rotation on pharyngeal swallowing in healthy subjects. Videofluoroscopic and oropharyngeal manometric examinations of pharyngeal swallowing were performed on seven volunteers with the head in neutral and rotated positions. Videofluoroscopic study revealed that head rotation swallow causes the bolus to lateralize away from the direction of head rotation. Pharyngeal manometric study indicated that the pharyngeal peak pressures toward the side of head rotation were significantly increased, whereas the pharyngeal pressures opposite the side of head rotation were not affected. Head rotation swallow produced a significant fall in upper esophageal sphincter (UES) resting pressure and a delay in UES closing. We concluded that the head rotation swallow in normal subjects not only alters the bolus pathway, but also has a useful effect on both pharyngeal clearance and UES dynamics.

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Esophageal Peristalsis Disorders in ALS Patients with Dysphagia

Brain Sciences ◽

10.3390/brainsci10110820 ◽

2020 ◽

Vol 10 (11) ◽

pp. 820

Author(s):

Jerzy Tomik ◽

Klaudia Sowula ◽

Mateusz Dworak ◽

Kamila Stolcman ◽

Małgorzata Maraj ◽

...

Keyword(s):

Esophageal Manometry ◽

Clinical Presentation ◽

Upper Esophageal Sphincter ◽

Esophageal Peristalsis ◽

Resting Pressure ◽

Esophageal Sphincter ◽

Risk Of Aspiration ◽

Als Patients ◽

Low Amplitude ◽

Lateral Sclerosis

To detect the variations of esophageal peristalsis in amyotrophic lateral sclerosis (ALS) patients with predominantly bulbar or predominantly pseudobulbar clinical presentation by using esophageal manometry (EM). Fifteen ALS patients with pseudobulbar clinical presentation (PBP) and 13 patients with bulbar presentation (BP), fulfilling WFN Criteria, were studied. EM was performed in all subjects using a flexible catheter with solid-state transducers. Swallowing was initiated with 5 to 10 mL of water (wet swallows) and saliva (dry swallows) and repeated at 30 s intervals. The manometric parameters were measured automatically and visualized by the computer system. The tracings were analyzed using Synectics software. In PBP patients, an increase of resting pressure value in the upper esophageal sphincter (UES) >45 mmHg, a wave-like course of resting pressure, and toothed peristaltic waves were observed. In BP patients, a low amplitude of peristaltic waves <30 mmHg (mean: 17 ± 5) was recorded, without signs of esophageal motility disturbance at onset or during progression. EM procedure allows objectively distinguishing dysphagia in ALS patients due to bulbar syndrome from the dysphagia due to pseudobulbar syndrome. It is important to identify PBP patients because of their high risk of aspiration.

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Cricopharyngeal peroral endoscopic myotomy improves oropharyngeal dysphagia in patients with Parkinson’s disease

Endoscopy International Open ◽

10.1055/a-1562-7107 ◽

2021 ◽

Vol 09 (11) ◽

pp. E1811-E1819

Author(s):

Peter I. Wu ◽

Michal M. Szczesniak ◽

Taher Omari ◽

Thomas Y. Lam ◽

Marc Wong ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Oropharyngeal Dysphagia ◽

Symptomatic Improvement ◽

Upper Esophageal Sphincter ◽

Mean Difference ◽

Peroral Endoscopic Myotomy ◽

Life Questionnaire ◽

Endoscopic Myotomy ◽

The Mean

Abstract Background and study aims Oropharyngeal dysphagia (OPD) is prevalent in patients with Parkinson’s disease (PD). Upper esophageal sphincter (UES) dysfunction is an important pathophysiological factor for OPD in PD. The cricopharyngeus (CP) is the main component of UES. We assessed the preliminary efficacy of cricopharyngeal peroral endoscopic myotomy (C-POEM) as a treatment for dysphagia due to UES dysfunction in PD. Patients and methods Consecutive dysphagic PD patients with UES dysfunction underwent C-POEM. Swallow metrics derived using high-resolution pharyngeal impedance manometry (HRPIM) including raised UES integrated relaxation pressure (IRP), raised hypopharyngeal intrabolus pressure (IBP), reduced UES opening caliber and relaxation time defined UES dysfunction. Sydney Swallow Questionnaire (SSQ) and Swallowing Quality of Life Questionnaire (SWAL-QOL) at before and 1 month after C-POEM measured symptomatic improvement in swallow function. HRPIM was repeated at 1-month follow-up. Results C-POEM was performed without complications in all (n = 8) patients. At 1 month, there was an improvement in both the mean SSQ (from 621.5 to 341.8, mean difference –277.3, 95 %CI [–497.8, –56.7], P = 0.02) and SWAL-QOL (from 54.9 to 68.3, mean difference 9.1, 95 %CI [0.7, 17.5], P = 0.037) scores. Repeat HRPIM confirmed a decrease in both the mean UES IRP (13.7 mm Hg to 3.6 mm Hg, mean difference –10.1 mm Hg, 95 %CI [–16.3, –3.9], P = 0.007) and the mean hypopharyngeal IBP (23.5 mm Hg to 10.4 mm Hg, mean difference –11.3 mm Hg, 95 %CI [–17.2, –5.4], P = 0.003). Conclusions In dysphagic PD patients with UES dysfunction, C-POEM is feasible and enhances UES relaxation and reduces sphincteric resistance to flow during the swallow, thereby improving dysphagia symptoms.

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PS01.003: EVALUATION OF BOTH STANDARD AND NOVEL HRM METRICS OF THE UPPER ESOPHAGEAL SPHINCTER (UES) IN ACHALASIA AND REFLUX DISEASE. APPLICATION OF THE CONTRACTILE INTEGRAL IN THE UES

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.003 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 50-50

Author(s):

Tania Triantafyllou ◽

Charalampos Theodoropoulos ◽

Georgios Zografos ◽

Dimitrios Theodorou

Keyword(s):

Conflicts Of Interest ◽

Neuronal Damage ◽

Upper Esophageal Sphincter ◽

Control Group ◽

Residual Pressure ◽

Study Group ◽

High Resolution Manometry ◽

Esophageal Lumen ◽

Resting Pressure ◽

Esophageal Sphincter

Abstract Background The literature is still lacking thorough manometric analysis of the function of the Upper Esophageal Sphincter (UES) among patients with motility disorders. Assessment of the High Resolution Manometry (HRM) features of the UES may be the key in further understanding the manometric profile of achalasia and even predicting treatment outcome. Furthermore, the Contractile Integral (CI) may be a more representative measure of contractility of the UES too. Methods Achalasia patients (study group) and a control group of individuals underwent HRM. Resting pressure, residual pressure, UES length and the Landmark UES-CI corrected for respiration were analyzed and compared between the two groups. The UES-CI metric was calculated according to the method applied for the Distal Contractile Integral (DCI). Results 24 achalasia patients and 24 subjects consisting the control group with mean age 55.2 and 56.1, respectively, were enrolled. Although the mean UES length was found significantly lower in our study group (3.2 vs. 4.3, P = 0), mean residual pressure was found significantly higher among the same group as compared to controls (12.5 vs. 3, P = 0.01). Interestingly, we found a trend towards lower values of the corrected UES-CI in achalasia compared to the control group (132 vs. 207.8, P = 0.08). The resting pressure did not differ between the two groups. Conclusion Increased residual pressure values of the UES in achalasia compared to control group is a reasonable finding that indicates that UES may also be affected by the neuronal damage in this disorder or that the pressurization phenomenon (mainly in achalasia type II) disrupts the function of the UES during swallowing. However, results on the UES-CI in resting phase cannot confirm the hypothesis of higher risk of aspiration among achalasia patients whose esophageal lumen is known to present with incomplete clearance and stasis. Disclosure All authors have declared no conflicts of interest.

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Human upper esophageal sphincter pressure profile

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.1980.239.1.g49 ◽

1980 ◽

Vol 239 (1) ◽

pp. G49-G52 ◽

Cited By ~ 2

Author(s):

D. Gerhardt ◽

J. Hewett ◽

M. Moeschberger ◽

T. Shuck ◽

D. Winship

Keyword(s):

Peak Pressure ◽

Isotonic Saline ◽

Normal Subjects ◽

Pressure Profile ◽

Upper Esophageal Sphincter ◽

Sphincter Pressure ◽

Pressure Profiles ◽

Resting Pressure ◽

Esophageal Sphincter ◽

Pull Through

The pressure profile of the upper esophageal sphincter was characterized in nine normal subjects. Directionally oriented intraluminal pressures were recorded, at 0.5-cm intervals over a 6-cm segment that encompassed the sphincter, by a high-fidelity low-compliance recording system. The peak resting pressure was directed posteriorly, and the lowest pressures were recorded from the lateral orientations. Significant axial asymmetry was observed with peak posterior pressure 0.55 cm more distal than the anterior pressure. Calculations of variability of pressures recorded at each interval showed the peak pressure to be the most reproducible measurement for each subject. Isotonic saline and acid infusions into the esophagus distal to the sphincter resulted in increased sphincteric peak resting pressure (acid greater than saline). There was axial lengthening of the sphincteric pressure zone with infusion of acid and saline, but this observed increase in length was not significant except at the 50 mmHg level. Pressure profiles recorded during 0.5-cm station pull-throughs were virtually identical to those obtained by a rapid continuous pull-through technique.

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Upper esophageal sphincter resting pressure varies during esophageal manometry

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202014000300005 ◽

2014 ◽

Vol 27 (3) ◽

pp. 182-183 ◽

Cited By ~ 6

Author(s):

Daniel Tavares REZENDE ◽

Fernando A. M. HERBELLA ◽

Luciana C. SILVA ◽

Sebastião PANOCCHIA-NETO ◽

Marco G. PATTI

Keyword(s):

High Resolution ◽

Esophageal Manometry ◽

Striated Muscle ◽

Upper Esophageal Sphincter ◽

Standard Test ◽

Sphincter Pressure ◽

High Resolution Manometry ◽

Basal Pressure ◽

Resting Pressure ◽

Esophageal Sphincter

BACKGROUND: The upper esophageal sphincter is composed of striated muscle. The stress of intubation and the need to inhibit dry swallows during an esophageal manometry test may lead to variations in basal pressure of this sphincter. Upper esophageal sphincter is usually only studied at the final part of the test. Was observed during the performance of high resolution manometry that sphincter pressure may vary significantly over the course of the test. AIM: To evaluate the variation of the resting pressure of the upper esophageal sphincter during high resolution manometry. METHODS: Was evaluated the variation of the basal pressure of the upper esophageal sphincter during high resolution manometry. Were reviewed the high resolution manometry tests of 36 healthy volunteers (mean age 31 years, 55% females). The basal pressure of the upper esophageal sphincter was measured at the beginning and at the end of a standard test. RESULTS: The mean time of the test was eight minutes. The basal pressure of the upper esophageal sphincter was 100 mmHg at the beginning of the test and 70 mmHg at the end (p<0.001). At the beginning, one patient had hypotonic upper esophageal sphincter and 14 hypertonic. At the end of the test, one patient had hypotonic upper esophageal sphincter (same patient as the beginning) and seven hypertonic upper esophageal sphincter. CONCLUSION: A significant variation of the basal pressure of the upper esophageal sphincter was observed in the course of high resolution manometry. Probably, the value obtained at the end of the test may be more clinically relevant.

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Pharyngeal and upper esophageal sphincter manometry in humans

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.1990.258.2.g173 ◽

1990 ◽

Vol 258 (2) ◽

pp. G173-G178 ◽

Cited By ~ 11

Author(s):

J. A. Castell ◽

C. B. Dalton ◽

D. O. Castell

Keyword(s):

Response Rate ◽

Upper Esophageal Sphincter ◽

Pressure Measurements ◽

Bolus Size ◽

Resting Pressure ◽

Precise Quantification ◽

Manometric Studies ◽

Esophageal Sphincter ◽

Pressure Changes ◽

Rapid Pressure

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.

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