Dynamics of esophageal bolus transport in healthy subjects studied using multiple intraluminal impedancometry

1997 ◽  
Vol 273 (4) ◽  
pp. G958-G964 ◽  
Author(s):  
H. N. Nguyen ◽  
J. Silny ◽  
D. Albers ◽  
E. Roeb ◽  
C. Gartung ◽  
...  
Keyword(s):  
Temporal Resolution ◽  
Healthy Subjects ◽  
Upright Position ◽  
Bolus Transit ◽  
Test Conditions ◽  
Impedance Technique ◽  
Bolus Viscosity ◽  
Liquid Bolus ◽  
Bolus Propulsion ◽  
Different Parts

The dynamics of a bolus transport through the esophagus are largely unexplored. To study this physiological process, we applied multiple intraluminal impedancometry in 10 healthy subjects. Three different protocols were used: 1) liquid bolus administered with subject supine, 2) liquid bolus with subject upright, or 3) semisolid bolus with subject supine. Transit of different parts of a bolus (bolus head, body, and tail) was analyzed at different anatomic segments, namely the pharynx and the proximal, middle, and distal thirds of the esophagus. A characteristic pattern of bolus transport was seen in all subjects. Impedance changes related to air were observed preceding the bolus head. The bolus head propelled significantly faster than did the bolus body and tail. Pharyngeal bolus transit was significantly faster than esophageal bolus transit. Within the esophagus, bolus propulsion velocity gradually decreased. Bolus transport was significantly accelerated in the upright position and delayed with increase of bolus viscosity. In conclusion, the dynamics of a bolus transport from the pharynx into the stomach are complex. It varies within both different anatomic segments and different parts of the bolus and depends on bolus characteristics and test conditions. The spatial and temporal resolution of a bolus transport can be obtained by the impedance technique.

scholarly journals EFFECT OF SWALLOWED BOLUS VISCOSITY AND BODY POSITION ON ESOPHAGEAL TRANSIT, CONTRACTION AND PERCEPTION OF TRANSIT

2015 ◽  
Vol 52 (1) ◽  
pp. 27-31 ◽  
Author(s):  
Juciléia DALMAZO ◽  
Lilian Rose Otoboni APRILE ◽  
Roberto Oliveira DANTAS
Keyword(s):  
Supine Position ◽  
Body Position ◽  
Random Sequence ◽  
Sitting Position ◽  
Bolus Transit ◽  
Esophageal Transit ◽  
Asymptomatic Volunteers ◽  
Bolus Viscosity ◽  
Liquid Bolus ◽  
Esophageal Contraction

Background The esophagus has a different response in relation to the characteristics of a swallowed bolus. Bolus viscosity and body position may affect esophageal contraction and transit. Objectives To investigate the effect of bolus viscosity and body position on esophageal contraction, transit and perception. Methods Esophageal contraction, transit and perception of transit were evaluated in 26 asymptomatic volunteers, 13 men and 13 women aged 18-60 years, mean: 33.6 (12.2) years. Esophageal contraction (manometry) and transit (impedance) were measured with a solid state catheter with sensors located 5, 10, 15, and 20 cm from the lower esophageal sphincter. Each volunteer swallowed in duplicate and in random sequence a 5 mL low viscous (LV) liquid bolus of an isotonic drink with pH 3.3, and a 5 mL high viscous (HV) paste bolus, which was prepared with 7.5 g of instant food thickener diluted in 50 mL of water (pH: 6.4). Results Total bolus transit time, in the sitting position, was longer with the HV bolus than with the LV bolus. Esophageal transit was longer in the supine position than in the sitting position. Bolus head advance time was longer with the HV bolus than with the LV bolus in both positions. Contraction esophageal amplitude was higher in the supine position than in the sitting position. The perception of bolus transit was more frequent with the HV bolus than with the LV bolus, without differences related to position. Conclusions The viscosity of the swallowed bolus and body position during swallows has an influence on esophageal contractions, transit and perception of transit.

scholarly journals Flow time through esophagogastric junction derived during high-resolution impedance-manometry studies: a novel parameter for assessing esophageal bolus transit

2014 ◽  
Vol 307 (2) ◽  
pp. G158-G163 ◽  
Author(s):  
Zhiyue Lin ◽  
Hala Imam ◽  
Frèdèric Nicodème ◽  
Dustin A. Carlson ◽  
Chen-Yuan Lin ◽  
...  
Keyword(s):  
High Resolution ◽  
Los Angeles ◽  
Healthy Subjects ◽  
Esophagogastric Junction ◽  
Pressure Sensors ◽  
Flow Time ◽  
Upright Position ◽  
Outer Diameter ◽  
Bolus Transit ◽  
Crural Diaphragm

This study aimed to develop and validate a method to measure bolus flow time (BFT) through the esophagogastric junction (EGJ) using a high-resolution impedance-manometry (HRIM) sleeve. Ten healthy subjects were studied with concurrent HRIM and videofluoroscopy; another 15 controls were studied with HRIM alone. HRIM studies were performed using a 4.2-mm-outer diameter assembly with 36 pressure sensors at 1-cm intervals and 18 impedance segments at 2-cm intervals (Given Imaging, Los Angeles, CA). HRIM and fluoroscopic data from four barium swallows, two in the supine and two in the upright position, were analyzed to create a customized MATLAB program to calculate BFT using a HRIM sleeve comprising three sensors positioned at the crural diaphragm. Bolus transit through the EGJ measured during blinded review of fluoroscopy was almost identical to BFT calculated with the HRIM sleeve, with the nadir impedance deflection point used as the signature of bolus presence. Good correlation existed between videofluoroscopy for measurement of upper sphincter relaxation to beginning of flow [ R = 0.97, P < 0.001 (supine) and R = 0.77, P < 0.01 (upright)] and time to end of flow [ R = 0.95, P < 0.001 (supine) and R = 0.82, P < 0.01 (upright)]. The medians and interquartile ranges (IQR) of flow time though the EGJ in 15 healthy subjects calculated using the virtual sleeve were 3.5 s (IQR 2.3–3.9 s) in the supine position and 3.2 s (IQR 2.3–3.6 s) in the upright position. BFT is a new metric that provides important information about bolus transit through the EGJ. An assessment of BFT will determine when the EGJ is open and will also provide a useful method to accurately assess trans-EGJ pressure gradients during flow.

scholarly journals Baropodometric technology used to analyze types of weight-bearing during hemiparetic upright position

2012 ◽  
Vol 25 (3) ◽  
pp. 583-594 ◽  
Author(s):  
Lidiane Teles de Menezes ◽  
Paulo Henrique Ferreira de Araujo Barbosa ◽  
Abraão Souza Costa ◽  
Anderson Castro Mundim ◽  
Gabrielly Craveiro Ramos ◽  
...  
Keyword(s):  
Healthy Subjects ◽  
Center Of Pressure ◽  
Weight Bearing ◽  
Upright Position ◽  
The Other ◽  
Control Group ◽  
Gender And Age ◽  
Coordination System ◽  
Support Area ◽  
Arch Index

INTRODUCTION: Although baropodometric analysis has been published since the 1990s, only now it is found a considerable number of studies showing different uses in the rehabilitation. OBJECTIVE: To amplify the use of this technology, this research aimed to analyze baropodometric records during upright position of subjects with hemiparesis, describing a way to define weight-bearing profiles in this population. METHOD: 20 healthy subjects were matched by gender and age with 12 subjects with chronic spastic hemiparesis. This control group was formed to establish the limits of symmetry during weight-bearing distribution in the hemiparesis group. Next, hemiparesis group was submitted to procedures to measure baropodometric records used to provide variables related to the weight-bearing distribution, the arch index and the displacements in the center of pressure (CoP). Data were used to compare differences among kinds of weight-bearing distribution (symmetric, asymmetric toward non-paretic or paretic foot) and coordination system for CoP displacements. RESULTS: Hemiparesis group was compounded by eight symmetrics, eight asymmetrics toward non-paretic foot and four asymmetric toward paretic foot. Significant differences in the weight-bearing distributions between non-predominantly and predominantly used foot did not promote differences in the other baropodometric records (peak and mean of pressure, and support area). Mainly in the asymmetry toward non-paretic foot it was observed significant modifications of the baropodometric records. CONCLUSION: Baropodometric technology can be used to analyze weight-bearing distribution during upright position of subjects with hemiparesis, detecting different kinds of weight-bearing profiles useful to therapeutic programs and researches involving subjects with this disability.

Supine position decreases the ability of the nose to warm and humidify air

2001 ◽  
Vol 91 (6) ◽  
pp. 2459-2465 ◽  
Author(s):  
Paraya Assanasen ◽  
Fuad M. Baroody ◽  
Edward Naureckas ◽  
Julian Solway ◽  
Robert M. Naclerio
Keyword(s):  
Supine Position ◽  
Healthy Subjects ◽  
Air Conditioning ◽  
Upright Position ◽  
Nasal Mask ◽  
Total Water ◽  
Nasal Turbinate ◽  
Dry Air ◽  
Air Volume ◽  
Water Gradient

We tested the hypothesis that decreasing nasal air volume (i.e., increasing nasal turbinate blood volume) improves nasal air conditioning. We performed a randomized, two-way crossover study on the conditioning capacity of the nose in six healthy subjects in the supine and upright position. Cold, dry air (CDA) was delivered to the nose via a nasal mask, and the temperature and humidity of air were measured before it entered and after it exited the nasal cavity. The total water gradient (TWG) across the nose was calculated and represents the nasal conditioning capacity. Nasal volume decreased significantly from baseline without changing the mucosal temperature when subjects were placed in the supine position ( P < 0.01). TWG in supine position was significantly lower than that in upright position ( P < 0.001). In the supine position, nasal mucosal temperature after CDA exposure was significantly lower than that in upright position ( P < 0.01). Our data show that placing subjects in the supine position decreased the ability of the nose to condition CDA compared with the upright position, in contrast to our hypothesis.

scholarly journals SWALLOWING IN PATIENTS WITH LARYNGITIS

2018 ◽  
Vol 55 (1) ◽  
pp. 50-54 ◽  
Author(s):  
Isabela MODA ◽  
Hilton Marcos Alves RICZ ◽  
Lilian Neto AGUIAR-RICZ ◽  
Roberto Oliveira DANTAS
Keyword(s):  
Transit Time ◽  
Random Sequence ◽  
Acid Reflux ◽  
Bolus Transit ◽  
Normal Volunteers ◽  
Esophageal Ph ◽  
Solid Bolus ◽  
Oral Preparation ◽  
Pharyngeal Transit ◽  
Liquid Bolus

ABSTRACT BACKGROUND: Dysphagia is described as a complaint in 32% of patients with laryngitis. OBJECTIVE: The objective of this investigation was to evaluate oral and pharyngeal transit of patients with laryngitis, with the hypothesis that alteration in oral-pharyngeal bolus transit may be involved with dysphagia. METHODS: Videofluoroscopic evaluation of the swallowing of liquid, paste and solid boluses was performed in 21 patients with laryngitis, 10 of them with dysphagia, and 21 normal volunteers of the same age and sex. Two swallows of 5 mL liquid bolus, two swallows of 5 mL paste bolus and two swallows of a solid bolus were evaluated in a random sequence. The liquid bolus was 100% liquid barium sulfate and the paste bolus was prepared with 50 mL of liquid barium and 4 g of food thickener (starch and maltodextrin). The solid bolus was a soft 2.2 g cookie coated with liquid barium. Durations of oral preparation, oral transit, pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement and oral-pharyngeal transit were measured. All patients performed 24-hour distal esophageal pH evaluation previous to videofluoroscopy. RESULTS: The evaluation of 24-hour distal esophageal pH showed abnormal gastroesophageal acid reflux in 10 patients. Patients showed longer oral preparation for paste bolus and a faster oral transit time for solid bolus than normal volunteers. Patients with laryngitis and dysphagia had longer preparation for paste and solid boluses, and a faster oral transit time with liquid, paste and solid boluses. CONCLUSION: A longer oral preparation for paste and solid boluses and a faster transit through the mouth are associated with dysphagia in patients with laryngitis.

Age dependency of cardiovascular autonomic responses to head-up tilt in healthy subjects

2004 ◽  
Vol 96 (6) ◽  
pp. 2333-2340 ◽  
Author(s):  
Tomi Laitinen ◽  
Leo Niskanen ◽  
Ghislaine Geelen ◽  
Esko Länsimies ◽  
Juha Hartikainen
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
High Frequency ◽  
Healthy Subjects ◽  
Baroreflex Sensitivity ◽  
Low Frequency ◽  
Upright Position ◽  
Vascular Responses ◽  
Autonomic Responses ◽  
Head Up Tilt

In elderly subjects, heart rate responses to postural change are attenuated, whereas their vascular responses are augmented. Altered strategy in maintaining blood pressure homeostasis during upright position may result from various cardiovascular changes, including age-related cardiovascular autonomic dysfunction. This exploratory study was conducted to evaluate impact of age on cardiovascular autonomic responses to head-up tilt (HUT) in healthy subjects covering a wide age range. The study population consisted of 63 healthy, normal-weight, nonsmoking subjects aged 23–77 yr. Five-minute electrocardiogram and finger blood pressure recordings were performed in the supine position and in the upright position 5 min after 70° HUT. Stroke volume was assessed from noninvasive blood pressure signals by the arterial pulse contour method. Heart rate variability (HRV) and systolic blood pressure variability (SBPV) were analyzed by using spectral analysis, and baroreflex sensitivity (BRS) was assessed by using sequence and cross-spectral methods. Cardiovascular autonomic activation during HUT consisted of decreases in HRV and BRS and an increase in SBPV. These changes became attenuated with aging. Age correlated significantly with amplitude of HUT-stimulated response of the high-frequency component ( r = -0.61, P < 0.001) and the ratio of low-frequency to high-frequency power of HRV ( r = -0.31, P < 0.05) and indexes of BRS (local BRS: r = -0.62, P < 0.001; cross-spectral baroreflex sensitivity in the low-frequency range: r = -0.38, P < 0.01). Blood pressure in the upright position was maintained well irrespective of age. However, the HUT-induced increase in heart rate was more pronounced in the younger subjects, whereas the increase in peripheral resistance was predominantly observed in the older subjects. Thus it is likely that whereas the dynamic capacity of cardiac autonomic regulation decreases, vascular responses related to vasoactive mechanisms and vascular sympathetic regulation become augmented with increasing age.

Influence of posture on left ventricular long- and short-axis shortening

2002 ◽  
Vol 283 (4) ◽  
pp. H1302-H1306 ◽  
Author(s):  
Patrik Sundblad ◽  
Bengt Wranne
Keyword(s):  
Supine Position ◽  
Healthy Subjects ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Upright Position ◽  
Lateral Part ◽  
Short Axis ◽  
Spherical Form ◽  
End Diastolic Volume ◽  
Axis Length

End-diastolic volume and left ventricular stroke volume are increased in the supine compared with upright position, but the contribution of long-axis (LAS) and short-axis shortening (SAS) to these changes with change in posture has not been established. We examined long- and short-axis motion and dimensions with echocardiography in 10 healthy subjects in the upright and supine position. Long-axis length at end diastole was almost identical, whereas the diastolic short-axis diameter was increased in the supine position. At end systole, there was a decreased long-axis length and increased short-axis length in the supine vs. upright position. Both LAS and SAS were enhanced in supine vs. upright positions [LAS: 9.3 ± 2.2 vs. 15.1 ± 3.1 mm ( P < 0.001); SAS: 12.7 ± 3.2 vs. 16.3 ± 2.8 mm ( P < 0.001)], presumably via Starling mechanisms. LAS increased more in the lateral part of the mitral annulus than in the septal part [7.7 ± 2.6 vs. 4.0 ± 2.8 mm ( P < 0.006)], which implies that the more spherical form, in the supine position, induces more stretch at the lateral free wall than in the ventricular septum. These findings support the notion that Starling mechanisms affect systolic LAS.

Vascular pressure bands on high-resolution esophageal manometry with impedance studies

2019 ◽  
Vol 33 (3) ◽  
Author(s):  
Steffen Lis ◽  
Herit Vachhani ◽  
Samuel Tanner ◽  
Andrew Leopold ◽  
Samantha Zitomer ◽  
...  
Keyword(s):  
High Resolution ◽  
Esophageal Manometry ◽  
Upright Position ◽  
Bolus Transit ◽  
Esophageal Transit ◽  
Normal Volunteers ◽  
Horizontal Pressure ◽  
Esophageal Length ◽  
Normal Controls

ABSTRACT Horizontal pressure bands on high-resolution esophageal manometry with impedance (HREMI) tracings are often seen and thought to be due to cardiovascular structures compressing the esophagus. The aim of this study was to determine the prevalence and location of vascular pressure bands on HREMI studies and correlate these pressure bands to bolus clearance. HREMI studies in supine and upright positions from patients and normal volunteers were reviewed. Pressure bands were defined as bands of horizontal pressure greater than the 20 mmHg isobaric contour. Each swallow was reviewed with impedance to determine if bolus transit was impaired by the band. 38.6% of 251 patients and 36.4% of 11 normal controls had a pressure band present. There were a greater number of bands in supine versus upright position (patients: 130 vs. 25, P &lt; 0.001 and controls: 6 vs. 1). Patients with pressure bands had similar demographics (age, gender, BMI) compared to those without. Average distal contractile integral of bands was greater in supine compared to upright (133 ± 201 vs. 60 ± 148 mmHg cm s, P &lt; 0.05). Bands were commonly located clustered at 46 and 72% of esophageal length. Bolus transit was impaired by bands in 20.4% of supine and 14.0% of upright swallows. Vascular pressure bands can have a prominent appearance on HREMI studies, present in, being more prevalent and having greater pressure in the supine than the upright position. These vascular bands, when present, may impair esophageal transit.

Assessment of intraluminal impedance for the detection of pharyngeal bolus flow during swallowing in healthy adults

2006 ◽  
Vol 290 (1) ◽  
pp. G183-G188 ◽  
Author(s):  
Taher I. Omari ◽  
Nathalie Rommel ◽  
Michal M. Szczesniak ◽  
Sergio Fuentealba ◽  
Philip G. Dinning ◽  
...  
Keyword(s):  
Impedance Measurement ◽  
Posterior Pharyngeal Wall ◽  
Upper Esophageal Sphincter ◽  
Clearance Time ◽  
Pharyngeal Wall ◽  
Bolus Transit ◽  
Intraluminal Impedance ◽  
Time Patterns ◽  
Impedance Technique ◽  
Esophageal Impedance

Intraluminal impedance, a nonradiological method for assessing bolus flow within the gut, may be suitable for investigating pharyngeal disorders. This study evaluated an impedance technique for the detection of pharyngeal bolus flow during swallowing. Patterns of pharyngoesophageal pressure and impedance were simultaneously recorded with videofluoroscopy in 10 healthy volunteers during swallowing of liquid, semisolid, and solid boluses. The timing of bolus head and tail passage recorded by fluoroscopy was correlated with the timing of impedance drop and recovery at each recording site. Bolus swallowing produced a drop in impedance from baseline followed by a recovery to at least 50% of baseline. The timing of the pharyngeal and esophageal impedance drop correlated with the timing of the arrival of the bolus head. In the pharynx, the timing of impedance recovery was delayed relative to the timing of clearance of the bolus tail. In contrast, in the upper esophageal sphincter (UES) and proximal esophagus, the timing of impedance recovery correlated well with the timing of clearance of the bolus tail. Impedance-based estimates of pharyngoesophageal bolus clearance time correlated with true pharyngoesophageal bolus clearance time. Patterns of intraluminal impedance recorded in the pharynx during bolus swallowing are therefore more complex than those in the esophagus. During swallowing, mucosal contact between the tongue base and posterior pharyngeal wall prolongs the duration of pharyngeal impedance drop, leading to overestimation of bolus tail timing. Therefore, we conclude that intraluminal impedance measurement does not accurately reflect the bolus transit in the pharynx but does accurately reflect bolus transit across the UES and below.

Lingual Propulsive Pressures Across Consistencies Generated by the Anteromedian and Posteromedian Tongue by Healthy Young Adults

2012 ◽  
Vol 55 (3) ◽  
pp. 960-972 ◽  
Author(s):  
Laura L. Gingrich ◽  
Julie A. G. Stierwalt ◽  
Carlin F. Hageman ◽  
Leonard L. LaPointe
Keyword(s):  
Young Adults ◽  
Gender Difference ◽  
Repeated Measures ◽  
Tongue Pressure ◽  
Oral Performance ◽  
Repeated Measures Analysis ◽  
Bolus Viscosity ◽  
Bolus Propulsion ◽  
Posterior Tongue ◽  
Healthy Participants

Purpose In the present study, the authors investigated lingual propulsive pressures generated in the normal swallow by the anterior and posterior lingual segments for various consistencies and maximum isometric tasks. Method Lingual pressures for saliva, thin, and honey-thick liquid boluses were measured via the Iowa Oral Performance Instrument (IOPI Medical, Carnation, WA) at both anteromedian and posteromedian lingual segments of 62 healthy participants, ages 18–34 years (30 men, 32 women). Results A repeated-measures analysis of variance revealed that all lingual swallowing pressures were significantly greater at the anteromedian segment than at the posteromedian segment. Gender was not a significant factor; however, women exhibited greater swallowing pressures across all conditions. Lingual pressures increased as bolus viscosity increased. No significant interactions existed. Analysis of a subset of 30 participants revealed that men exhibited greater maximal isometric pressure at the anteromedian segment than women, with no significant gender difference at the posteromedian segment. A significantly higher percentage of maximum isometric tongue pressure was exerted by the posteromedian tongue than by the anteromedian tongue. Conclusion Findings suggest that greater amplitudes of lingual pressures are generated during normal swallowing at the anteromedian lingual segment; however, a greater percentage of maximum isometric tongue pressure was exerted by the posteromedian lingual segment, suggesting increased effort by the posterior tongue during bolus propulsion.

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