Sa172 NORMATIVE VALUES FOR ESOPHAGEAL HIGH-RESOLUTION MANOMETRY IN PATIENTS WITH OBESITY

The vastly enhanced spatial resolution of high-resolution manometry (HRM) makes it possible to simultaneous monitor contractile activity over the entire length of the esophagus. The aim of this investigation was to define the essential features of esophageal peristalsis in novel HRM paradigms and establish their normative values. Ten 5-ml water swallows were recorded in each of 75 asymptomatic controls with a solid-state manometric assembly incorporating 36 circumferential sensors spaced at 1-cm intervals positioned to record from the hypopharynx to the stomach. The data set was then subjected to intensive computational analysis to distill out the essential characteristics of normal peristalsis. Esophageal peristalsis was conceptualized in terms of a proximal contraction, a distal contraction, and a transition zone separating the two. Each contractile segment was quantified in length and then normalized among subjects to summarize focal fluctuation of contractile amplitude and propagation velocity. Furthermore, the temporal and spatial characteristics of the transition zone separating the proximal and distal contraction were quantified. For each paradigm, graphics were developed, establishing median values along with the 5th to 95th percentile range of observed variation. In addition, the synchronization between peristalsis and esophagogastric junction relaxation was analyzed using a novel concept of the outflow permissive pressure gradient. We performed a detailed analysis of esophageal peristalsis aimed at quantifying its essential features and, in so doing, devised new paradigms for the quantification of peristaltic function that will hopefully optimize the utility of HRM in clinical and investigative studies.

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VALIDATION OF A NEW WATER-PERFUSED HIGH-RESOLUTION MANOMETRY SYSTEM

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-672020200004e1557 ◽

2020 ◽

Vol 33 (4) ◽

Author(s):

Rogério MARIOTTO ◽

Fernando A. M. HERBELLA ◽

Vera Lucia Ângelo ANDRADE ◽

Francisco SCHLOTTMANN ◽

Marco G. PATTI

Keyword(s):

High Resolution ◽

Normal Values ◽

Ph Monitoring ◽

Low Cost ◽

Normative Values ◽

High Resolution Manometry ◽

Group 4 ◽

Group 3 ◽

Group 2 ◽

Group 1

ABSTRACT Background: High-resolution manometry is more costly but clinically superior to conventional manometry. Water-perfused systems may decrease costs, but it is unclear if they are as reliable as solid-state systems, and reference values are interchangeable. Aim: To validate normal values for a new water-perfusion high-resolution manometry system. Methods: Normative values for a 24-sensors water perfused high-resolution manometry system were validated by studying 225 individuals who underwent high resolution manometry for clinical complaints. Patients were divided in four groups: group 1 - gastroesophageal reflux disease; group 2 - achalasia; group 3 - systemic diseases with possible esophageal manifestation; and group 4 - dysphagia. Results: In group 1, a hypotonic lower esophageal sphincter was found in 49% of individuals with positive 24 h pH monitoring, and in 28% in pH-negative individuals. In groups 2 and 3, aperistalsis was found in all individuals. In group 4, only one patient (14%) had normal high-resolution manometry. Conclusions: The normal values determined for this low-cost water-perfused HRM system with unique peristaltic pump and helicoidal sensor distribution are discriminatory of most abnormalities of esophageal motility seen in clinical practice.

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Normative values in esophageal high-resolution manometry

Neurogastroenterology & Motility ◽

10.1111/nmo.12500 ◽

2014 ◽

Vol 27 (2) ◽

pp. 175-187 ◽

Cited By ~ 54

Author(s):

T. V. K. Herregods ◽

S. Roman ◽

P. J. Kahrilas ◽

A. J. P. M. Smout ◽

A. J. Bredenoord

Keyword(s):

High Resolution ◽

Normative Values ◽

High Resolution Manometry

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High-resolution manometry assessment of the lower esophageal sphincter after-contraction: Normative values and clinical correlation

Neurogastroenterology & Motility ◽

10.1111/nmo.13156 ◽

2017 ◽

Vol 30 (1) ◽

pp. e13156 ◽

Cited By ~ 2

Author(s):

D. A. Carlson ◽

P. J. Kahrilas ◽

M. Tye ◽

Z. Listernick ◽

K. Ritter ◽

...

Keyword(s):

High Resolution ◽

Lower Esophageal Sphincter ◽

Normative Values ◽

Clinical Correlation ◽

High Resolution Manometry ◽

Esophageal Sphincter

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Normative values and inter-observer agreement for liquid and solid bolus swallows in upright and supine positions as assessed by esophageal high-resolution manometry

Neurogastroenterology & Motility ◽

10.1111/j.1365-2982.2011.01682.x ◽

2011 ◽

Vol 23 (6) ◽

pp. 509-e198 ◽

Cited By ~ 104

Author(s):

R. Sweis ◽

A. Anggiansah ◽

T. Wong ◽

E. Kaufman ◽

S. Obrecht ◽

...

Keyword(s):

High Resolution ◽

Observer Agreement ◽

Normative Values ◽

High Resolution Manometry ◽

Solid Bolus

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NORMATIVE VALUES FOR A NEW WATER-PERFUSED HIGH RESOLUTION MANOMETRY SYSTEM

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.201800000-40 ◽

2018 ◽

Vol 55 (suppl 1) ◽

pp. 30-34 ◽

Cited By ~ 5

Author(s):

Rogério Mariotto Bitetti da SILVA ◽

Fernando A M HERBELLA ◽

Daniel GUALBERTO

Keyword(s):

High Resolution ◽

Low Cost ◽

Upper Esophageal Sphincter ◽

Normative Values ◽

Residual Pressure ◽

High Resolution Manometry ◽

Pressure Transducers ◽

Basal Pressure ◽

Esophageal Sphincter ◽

Body Parameters

ABSTRACT BACKGROUND: Esophageal manometry is the most reliable method to evaluate esophageal motility. High resolution manometry (HRM) provides topographic contour colored plots (Clouse Plots) with simultaneous analysis from the pharynx to the stomach. Both solid state and water-perfused systems are available. OBJECTIVE: This study aims to determinate the normative data for a new water-perfused HRM. METHODS: HRM was made in 32 healthy volunteers after 8 hours fasting. HRM system used consisted of a 24-channel water-perfused catheter (Multiplex, Alacer Biomedica, São Paulo, Brazil). The reusable catheter is made of polyvinyl chloride (PVC) with 4.7 mm of diameter. Side holes connected to pressure transducers are spaced 2 cm for the analysis from the pharynx to the lower esophageal sphincter (LES). Holes are spaced 5 mm and 120° in a spiral disposition in the LES area. The sensors encompass 34 cm in total. Upper esophageal sphincter (UES) parameters studied were basal and relaxation pressures. Esophageal body parameters were distal contractile integral (DCI), distal latency (DL) and break. LES parameters studied were basal pressure, integrated residual pressure (IRP), total and abdominal length. Variables are expressed as mean ± standard deviation, median (interquartile range) and percentiles 5-95th. RESULTS: All volunteers (17 males, aged 22-62 years) completed the study and tolerated the HRM procedure well. Percentiles 5-95th range were calculated: Upper Esophageal Sphincter (UES) basal pressure 16.7-184.37 (mmHg), DL: 6.2-9.1 (s), DCI: 82.72-3836.61 (mmHg.s.cm), break: <7.19 (cm), LES basal pressure: 4.89-37.16 (mmHg), IRP: 0.55-15.45 (mmHg). CONCLUSION: The performance and normative values obtained for this low-cost water-perfused HRM seems to be adequate for clinical use.

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Deglutitive upper esophageal sphincter relaxation: a study of 75 volunteer subjects using solid-state high-resolution manometry

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00081.2006 ◽

2006 ◽

Vol 291 (3) ◽

pp. G525-G531 ◽

Cited By ~ 119

Author(s):

Sudip K. Ghosh ◽

John E. Pandolfino ◽

Qing Zhang ◽

Andrew Jarosz ◽

Peter J. Kahrilas

Keyword(s):

Solid State ◽

High Resolution ◽

Detailed Analysis ◽

Automated Analysis ◽

Upper Esophageal Sphincter ◽

Normative Values ◽

Bolus Volume ◽

High Resolution Manometry ◽

Pressure Profiles ◽

Esophageal Sphincter

This study aimed to use a novel high-resolution manometry (HRM) system to establish normative values for deglutitive upper esophageal sphincter (UES) relaxation. Seventy-five asymptomatic controls were studied. A solid-state HRM assembly with 36 circumferential sensors spaced 1 cm apart was positioned to record from the hypopharynx to the stomach. Subjects performed ten 5-ml water swallows and one each of 1-, 10-, and 20-ml volume swallows. Pressure profiles across the UES were analyzed using customized computational algorithms that measured 1) the relaxation interval (RI), 2) the median intrabolus pressure (mIBP) during the RI, and 3) the deglutitive sphincter resistance (DSR) defined as mIBP/RI. The automated analysis succeeded in confirming bolus volume modulation of both the RI and the mIBP with the mean RI ranging from 0.32 to 0.50 s and mIBP ranging from 5.93 to 13.80 mmHg for 1- and 20-ml swallows, respectively. DSR was relatively independent of bolus volume. Peak pharyngeal contraction during the return to the resting state postswallow was almost 300 mmHg, again independent of bolus volume. We performed a detailed analysis of deglutitive UES relaxation with a novel HRM system and customized software. The enhanced spatial resolution of HRM allows for the accurate, automated assessment of UES relaxation and intrabolus pressure characteristics, in both cases confirming the volume-dependent effects and absolute values of these parameters previously demonstrated by detailed analysis of concurrent manometry/fluoroscopy data. Normative values were established to aid in future clinical and investigative studies.

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