Manometric Studies of the Upper Esophageal Sphincter

1977 ◽  
Vol 86 (5) ◽  
pp. 598-602 ◽  
Author(s):  
Barry P. Berlin ◽  
Francis Tedesco ◽  
Jeffrey T. Fierstein ◽  
Joseph H. Ogura
Keyword(s):  
Clinical Evidence ◽  
Marked Decrease ◽  
Upper Esophageal Sphincter ◽  
Intraluminal Pressure ◽  
Laryngeal Surgery ◽  
Pressure Profiles ◽  
Posterior Direction ◽  
Manometric Studies ◽  
Esophageal Sphincter ◽  
Anterior Posterior

The pharyngoesophageal sphincter (PES) has been studied extensively using the standard three lumen esophageal catheter. Studies using this catheter are nonreproduciible because intraluminal pressure in the PES is dependent on the orientation of the catheter. This difficulty was overcome when a multiluminal catheter was developed by Winans. In this work we used a modification of this multiluminal catheter to study the PES in 6 normal patients and in 13 patients who had undergone partial laryngeal surgery. Pressure profiles in the six normal patients revealed a marked increase in intraluminal pressure in the anterior-posterior direction. This is explained by the anatomy of the cricopharyngeal muscle which does not insert in a median raphe. These readings were reliable and reproducible. The operative patients included nine subtotal supraglottic laryngectomies and four partial laryngopharyngectomies. Eight patients had a cricopharyngeal myotomy and five did not. Pre- and postoperative measurements in this series revealed a marked decrease in PES pressure in those patients who had a myotomy; however, all patients were decannulated and swallowed postoperatively without clinical evidence of aspiration. All future manometric studies of the PES should employ a multilumined catheter in order that the differential pressures in the upper esophagus are recorded.

Videoradiographic, manometric, and electromyographic analysis of canine upper esophageal sphincter

1991 ◽  
Vol 260 (6) ◽  
pp. G911-G919 ◽  
Author(s):  
I. M. Lang ◽  
R. O. Dantas ◽  
I. J. Cook ◽  
W. J. Dodds
Keyword(s):  
Upper Esophageal Sphincter ◽  
Intraluminal Pressure ◽  
Emg Activity ◽  
Dimensional Changes ◽  
Pressure Profiles ◽  
Esophageal Sphincter ◽  
Pull Through ◽  
Electromyographic Analysis ◽  
Ues Opening ◽  
Static Conditions

We assessed upper esophageal sphincter (UES) function in dogs by concurrent recording of cricopharyngeal electromyographic (EMG) activity, intraluminal pressure, and dimensional changes of the pharyngoesophageal junction at rest and during swallowing. Radial and axial pressure profiles of the UES were determined by continuous pull-through manometry. EMG activity of the cricopharyngeus and thyropharyngeus muscles were correlated with UES pressure under static conditions. We also quantified the temporal relationships among EMG activity of the cricopharyngeus, UES pressure, and pharyngoesophageal junction dimensional changes during swallowing of 2, 4, and 6 ml of barium. When the dogs were prone, the anterior and posterior UES pressures were about twice the lateral pressures and the axial length of the UES was approximately 4 cm. All radial pressures equalized to approximately 20 mmHg when the dogs lay on their sides. The peak pressure zone of the UES corresponded closely with the level of the cricopharyngeal electrode, and resting UES pressure correlated closely with cricopharyngeal but not thyropharyngeal EMG activity. During swallowing, the cricopharyngeus relaxed approximately 200 ms before UES opening and 100 ms before UES relaxation. Superior movement of the hyoid and the larynx was associated temporally with UES relaxation, while anterior movement was associated with UES opening. Increases in bolus volume significantly increased maximal sagittal UES diameter during UES opening but did not alter temporal changes in UES function.(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals Predicting the activation states of the muscles governing upper esophageal sphincter relaxation and opening

2016 ◽  
Vol 310 (6) ◽  
pp. G359-G366 ◽  
Author(s):  
Taher I. Omari ◽  
Corinne A. Jones ◽  
Michael J. Hammer ◽  
Charles Cock ◽  
Philip Dinning ◽  
...  
Keyword(s):  
Sensory Information ◽  
Upper Esophageal Sphincter ◽  
Intraluminal Pressure ◽  
Emg Activity ◽  
Motor Behaviors ◽  
Pharyngeal Pressure ◽  
Intraluminal Impedance ◽  
Esophageal Sphincter ◽  
Ues Opening ◽  
Swallowing Muscles

The swallowing muscles that influence upper esophageal sphincter (UES) opening are centrally controlled and modulated by sensory information. Activation and deactivation of neural inputs to these muscles, including the intrinsic cricopharyngeus (CP) and extrinsic submental (SM) muscles, results in their mechanical activation or deactivation, which changes the diameter of the lumen, alters the intraluminal pressure, and ultimately reduces or promotes flow of content. By measuring the changes in diameter, using intraluminal impedance, and the concurrent changes in intraluminal pressure, it is possible to determine when the muscles are passively or actively relaxing or contracting. From these “mechanical states” of the muscle, the neural inputs driving the specific motor behaviors of the UES can be inferred. In this study we compared predictions of UES mechanical states directly with the activity measured by electromyography (EMG). In eight subjects, pharyngeal pressure and impedance were recorded in parallel with CP- and SM-EMG activity. UES pressure and impedance swallow profiles correlated with the CP-EMG and SM-EMG recordings, respectively. Eight UES muscle states were determined by using the gradient of pressure and impedance with respect to time. Guided by the level and gradient change of EMG activity, mechanical states successfully predicted the activity of the CP muscle and SM muscle independently. Mechanical state predictions revealed patterns consistent with the known neural inputs activating the different muscles during swallowing. Derivation of “activation state” maps may allow better physiological and pathophysiological interpretations of UES function.

Human upper esophageal sphincter pressure profile

1980 ◽  
Vol 239 (1) ◽  
pp. G49-G52 ◽  
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.

Volitional augmentation of upper esophageal sphincter opening during swallowing

1991 ◽  
Vol 260 (3) ◽  
pp. G450-G456 ◽  
Author(s):  
P. J. Kahrilas ◽  
J. A. Logemann ◽  
C. Krugler ◽  
E. Flanagan
Keyword(s):  
Normal Subjects ◽  
Upper Esophageal Sphincter ◽  
Biomechanical Analysis ◽  
Intraluminal Pressure ◽  
Mendelsohn Maneuver ◽  
Before And After ◽  
Esophageal Sphincter ◽  
Ues Opening

Studies were done on eight normal subjects with synchronized videofluoroscopy and manometry to facilitate a biomechanical analysis of the extent and mechanism of voluntary augmentation of upper esophageal sphincter (UES) opening during swallowing. Movements of the hyoid and larynx, dimensions of sphincter opening, and intraluminal pressure events were determined at 1/30-s intervals during swallows of 1 and 10 ml of liquid barium. Swallows of each volume were obtained both before and after subjects were taught a maneuver designed to augment UES opening, the Mendelsohn maneuver (voluntary prolongation of laryngeal excursion at the midpoint of the swallow). At either volume, use of the maneuver increased the duration of the anterior-superior excursion of the larynx and hyoid and consequently delayed sphincter closure by maintaining traction on the anterior sphincter wall. The onset of the pharyngeal contraction (the event normally culminating in sphincter closure) was not affected by the maneuver. We conclude that swallow-related hyoid motion, laryngeal motion, and UES opening are subject to volitional augmentation, supporting the notion that biofeedback techniques can be used to modify impaired swallowing.

Pharyngeal and upper esophageal sphincter manometry in humans

1990 ◽  
Vol 258 (2) ◽  
pp. G173-G178 ◽  
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.

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

2006 ◽  
Vol 291 (3) ◽  
pp. G525-G531 ◽  
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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