Esophageal Peristalsis Disorders in ALS Patients with Dysphagia

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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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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Esophageal manometry in the opossum.

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.1977.233.3.e152 ◽

1977 ◽

Vol 233 (3) ◽

pp. E152

Author(s):

K Schulze ◽

W J Dodds ◽

J Christensen ◽

J D Wood

Keyword(s):

Animal Model ◽

Lower Esophageal Sphincter ◽

Esophageal Manometry ◽

Lower Esophageal Sphincter Pressure ◽

Upper Esophageal Sphincter ◽

Sphincter Pressure ◽

Coronal Section ◽

Esophageal Sphincter ◽

Human Esophagus

The opossum esophagus is commonly used as an animal model of the human esophagus. We used esophageal manometry in normal animals to provide basal data about normal esophageal motor functions in vivo in this species. At rest, separate and distinct high pressure zones can be recorded at the level of the lower esophageal sphincter, diaphragmatic hiatus, aortic arch, and upper esophageal sphincter. Each zone demonstrates a characteristic pattern of pressures in the radii of the coronal section and a characteristic response to swallowing. The hiatal and aortic zones can be mistaken for the esophageal sphincters. Pressures in the sphincters fall with swallowing. Peristalsis is not bolus-dependent and occurs with 98% of swallows. Pressures generated by peristalsis are greater in the middle of the esophagus than at the ends. Values for resting lower esophageal sphincter pressure and the characteristics of peristalsis were reproducible between different studies in the same animals.

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Effect of aging and bolus variables on pharyngeal and upper esophageal sphincter motor function

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.1993.264.3.g427 ◽

1993 ◽

Vol 264 (3) ◽

pp. G427-G432 ◽

Cited By ~ 25

Author(s):

R. Shaker ◽

J. Ren ◽

B. Podvrsan ◽

W. J. Dodds ◽

W. J. Hogan ◽

...

Keyword(s):

Pressure Wave ◽

Wave Amplitude ◽

Age Groups ◽

The Elderly ◽

Young Group ◽

Upper Esophageal Sphincter ◽

Healthy Elderly ◽

Pressure Wave Amplitude ◽

Resting Pressure ◽

Esophageal Sphincter

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

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s004050100401 ◽

2001 ◽

Vol 258 (10) ◽

pp. 552-556 ◽

Cited By ~ 16

Author(s):

R. Higo ◽

N. Tayama ◽

T. Watanabe ◽

S. Niimi

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Upper Esophageal Sphincter ◽

Resting Pressure ◽

Esophageal Sphincter

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Effect of time interval between swallows on esophageal peristalsis

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.1980.238.6.g485 ◽

1980 ◽

Vol 238 (6) ◽

pp. G485-G490 ◽

Cited By ~ 6

Author(s):

P. Ask ◽

L. Tibbling

Keyword(s):

High Amplitude ◽

Upper Esophageal Sphincter ◽

Peristaltic Wave ◽

Time Interval ◽

Pressure Amplitude ◽

Esophageal Peristalsis ◽

Transport Function ◽

Wave Duration ◽

Esophageal Sphincter ◽

Different Parts

Esophageal peristaltic pressure amplitude, peristaltic incidence, speed of peristalsis, and wave duration were investigated as a function of swallow interval. In the distal half of the esophagus, the amplitude decreased at swallow intervals of 8 s and shorter. At intervals of 8 and 4 s, dropouts of contractions that were obtained were most frequent in the distal esophagus and for the 4-s interval. At continuous swallows no contractions were obtained below the upper esophageal sphincter until the end of the swallow sequence, after which a peristaltic wave of high amplitude propagated along the esophagus. The peristaltic speed increased toward a level 5 cm above the lower esophageal sphincter. The peristaltic wave duration was approximately the same in different parts of the esophagus and at different swallow intervals. The findings indicate an impairment of esophageal transport function by short swallow intervals.

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Systematic Review of Pharyngeal and Esophageal Manometry in Healthy or Dysphagic Older Persons (>60 years)

Geriatrics ◽

10.3390/geriatrics3040067 ◽

2018 ◽

Vol 3 (4) ◽

pp. 67 ◽

Cited By ~ 10

Author(s):

Charles Cock ◽

Taher Omari

Keyword(s):

Systematic Review ◽

Clinical Studies ◽

Esophageal Manometry ◽

Flow Resistance ◽

Young Patients ◽

Upper Esophageal Sphincter ◽

Noncardiac Chest Pain ◽

Older Individuals ◽

Show Evidence ◽

Esophageal Sphincter

We undertook a systematic review of swallowing biomechanics, as assessed using pharyngeal and esophageal manometry in healthy or dysphagic older individuals aged over 60 years of age, comparing findings to studies of younger participants. PRISMA-P methodology was used to identify, select, and evaluate eligible studies. Across studies, older participants had lower upper esophageal sphincter (UES) resting pressures and evidence of decreased UES relaxation when compared to younger groups. Intrabolus pressures (IBP) above the UES were increased, demonstrating flow resistance at the UES. Pharyngeal contractility was increased and prolonged in some studies, which may be considered as an attempt to compensate for UES flow resistance. Esophageal studies show evidence of reduced contractile amplitudes in the distal esophagus, and an increased frequency of failed peristaltic events, in concert with reduced lower esophageal sphincter relaxation, in the oldest subjects. Major motility disorders occurred in similar proportions in older and young patients in most clinical studies, but some studies show increases in achalasia or spastic motility in older dysphagia and noncardiac chest pain patients. Overall, study qualities were moderate with a low likelihood of bias. There were few clinical studies specifically focused on swallowing outcomes in older patient groups and more such studies are needed.

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