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Background Distensibility evaluation of the esophageal body using the functional lumen imaging probe (FLIP) offers an objective measure to characterize patients with eosinophilic esophagitis (EoE), though this analysis may be limited by unrecognized catheter movement and esophageal contractility. The aims of this study were to report novel FLIP analytic methods of esophageal distensibility measurement in EoE and to assess the effect of contractility. Methods Nine healthy controls (six female; ages 20–49) and 20 EoE patients (four female; ages 19–64; grouped by degree of distension-mediated contractility identified on FLIP) were evaluated with a 16-cm FLIP device during step-wise balloon distension during upper endoscopy. A distensibility plateau (DP) was generated using multiple methods to identify the narrowest esophageal body diameter: (i) wavelet decomposition (WD), (ii) maximal diameter (MD), and (iii) FLIP Analytics software. Key Results Distensibility was reduced in EoE patients compared with controls using the WD (p = 0.002) and MD (p = 0.001) methods; a trend was detected using the FLIP Analytics method (p = 0.055). Significant intra-subject differences were detected between methods among both patients and controls (p-values

BACKGROUND The results of the esophageal body motility differences between liquid and solid swallows from high-resolution manometry (HRM) studies are not consistent. The information of the frequency of ineffective liquid and solid bolus swallows in healthy individuals during HRM procedure is limited. The normative values of the HRM parameters of both liquid and solid swallows for Chinese population are lacking. METHODS The esophageal HRM data of 101 healthy volunteers from multicenters in China were analyzed. The values of the HRM parameters were summarized and compared between liquid and solid swallows. The frequencies of ineffective liquid and solid swallows were summarized. RESULTS Esophagus contracted stronger and slower in solid bolus swallows than water swallows with HREM. Ineffective water swallow (DCI

Background This study aimed to evaluate the spatial variation in esophageal distensibility in normal subjects using a novel multichannel functional luminal imaging probe (FLIP). Methods Ten healthy subjects (four men, age 21–49 years) were evaluated during endoscopy with a high-resolution impedance planimetry probe (FLIP) positioned through the esophagogastric junction (EGJ) and distal 10 cm of the esophageal body. Stepwise bag distensions using 5-mL increments from 0 to 60 mL were conducted, and simultaneous measurements of cross-sectional area (CSA) and the associated intrabag pressure from each subject were analyzed using a customized MATLAB™ program. The distensibility along the esophagus was determined and compared between the EGJ and interval locations at 2–5 cm and 6–10 cm above the EGJ. Key Results The pressure–CSA relationship was nearly linear among sites at lower pressures (0 to 7.5 mmHg) and reached a distension plateau at pressures ranging from 8 to 24 mmHg. The location of greatest distensibility was 4 cm above the EGJ. Although the CSAs of individual recording loci were not significantly different, there was a significant difference between the mean CSAs when comparing the region 2 to 5 cm proximal to EGJ with that 6 to 10 cm proximal to the EGJ. Conclusions & Inferences There were significant regional differences in distensibility along the distal esophagus with lower values in the proximal part compared with more distal part. The greatest distensibility was noted to occur at about 4 cm above the EGJ in close proximity to the location of the contractile deceleration point and phrenic ampulla.

The following contains commentaries on distensibility testing using the functional lumen imaging probe (FLIP); the use of the distention test of the esophageal body in the clinic diagnosis of noncardiac chest pain; the functional lumen imaging in gastroesophageal reflux disease-impaired esophagogastric junction; a multimodal pain model for the esophagus; the rationale for distensibility testing; and further developments in standardized distension protocols.

A new method for automatic analysis of resting lower esophageal sphincter pressure and postdeglutitive motor activity of esophageal body and lower esophageal sphincter (LES) is validated by comparing the results obtained with automatic and manual analysis of 11,700 esophageal body pressure peaks, 390 resting LES pressure measurements, and 3900 LES relaxations. The automatic analysis is based on the on-line transformation of pressure recordings into a mathematical formula using B-spline functions, which allows one to use the same parameters as those generally applied in manual analysis of esophageal manometric recordings. Statistical evaluation of the results indicates that this method provides a faithful analysis of the pressure tracings. The difference between manual and automatic analysis (mean ± SD) was only + 1.49 ± 4.26 mm Hg for wave amplitude, -0.15 ± 0.61 seconds for wave duration, +0.37 ± 1.05 cm/second for progression velocity, +0.95 ± 1.38 mm Hg for resting LES pressure, and -2.0 ± 1.67 mm Hg for residual LES pressure after deglutition. Wave form was correctly recognized in 95.3% of the waves. Pressure recordings were obtained from a study on the effect of the PGE1 analogue rioprostil (600 and 300 μg), administered orally on esophageal motor function in 10 normal volunteers. The drug increased both the resting LES pressure and the amplitude of esophageal body contractions and decreased the completeness of LES relaxation after swallowing.

Changes in resistance to flow at the esophagogastric junction contribute to the regulation of esophageal emptying and gastroesophageal reflux. To quantify esophagogastric resistance in man we have adapted our pneumatic resistometer, previously validated in the dog. The system is based on the measurement of nitrogen flow through a 5-cm-long polyurethane cylinder placed within the gut lumen and maintained electronically at a constant pressure gradient. In vitro experiments showed that the amplitude, length, and diameter of the constricted segment each contribute to resistance as measured by our instrument. In vivo studies performed on eight healthy volunteers showed that the esophagogastric junction was the place of maximal resistance in the gastroesophageal region. Intragastric resistance was also comparatively high whereas esophageal body resistance was negligible. Esophagogastric junction resistance was similar for antegrade and retrograde flow. During swallowing, it decreased to 10% of resting values. In three patients with achalasia, it was markedly increased and did not vary significantly during swallowing. We conclude that pneumatic resistometry accurately quantitates segmental resistance to flow in the esophagogastric region. Under normal conditions esophagogastric junction resistance exceeds gastric resistance and, hence, provides a gradient against gastroesophageal reflux. However, this resistance gradient between the junction and the stomach is much narrower than previously thought on the basis of manometric measurements.

The relative importance of cortical and infracortical neural control of deglutition was investigated in nine patients with unilateral cortical or internal capsule stroke, six patients with idiopathic parkinsonism, and seven healthy volunteers. Ten dry then 10 wet swallows were requested, during a right and left electromyographic recording of the mylohyoideus muscles, coupled to a manometric recording of the pharynx, upper esophageal sphincter, esophageal body, and lower esophageal sphincter (LES). Six hemiplegic patients, but no patient with Parkinson's disease, had asynchronous contractions of the mylohyoideus muscle at the onset of swallowing. Four hemiplegic patients and one with Parkinson's disease were unable to trigger dry swallows, but wet swallows were always initiated in all subjects. Four hemiplegic patients and one with Parkinson's disease had nonperistaltic esophageal contractions with either dry or wet swallows. LES relaxation was complete after dry swallows in none of the hemiplegic patients and in two with Parkinsons disease, and after wet swallows in six hemiplegic patients and four with Parkinson's disease. We conclude that a unilateral stroke may abolish the synchronism of mylohyoideus muscle contractions during swallowing, and that both pharyngeal and esophageal stages of deglutition are impaired in either cortical or striatonigral lesions.

Background High-resolution manometry (HRM) has resulted in new revelations regarding the pathophysiology of gastro-esophageal reflux disease (GERD). The impact of new HRM motor paradigms on reflux burden needs further definition, leading to a modern approach to motor testing in GERD. Methods Focused literature searches were conducted, evaluating pathophysiology of GERD with emphasis on HRM. The results were discussed with an international group of experts to develop a consensus on the role of HRM in GERD. A proposed classification system for esophageal motor abnormalities associated with GERD was generated. Key Results Physiologic gastro-esophageal reflux is inherent in all humans, resulting from transient lower esophageal sphincter (LES) relaxations that allow venting of gastric air in the form of a belch. In pathological gastro-esophageal reflux, transient LES relaxations are accompanied by reflux of gastric contents. Structural disruption of the esophagogastric junction (EGJ) barrier, and incomplete clearance of the refluxate can contribute to abnormally high esophageal reflux burden that defines GERD. Esophageal HRM localizes the LES for pH and pH-impedance probe placement, and assesses esophageal body peristaltic performance prior to invasive antireflux therapies and antireflux surgery. Furthermore, HRM can assess EGJ and esophageal body mechanisms contributing to reflux, and exclude conditions that mimic GERD. Conclusions & Inferences Structural and motor EGJ and esophageal processes contribute to the pathophysiology of GERD. A classification scheme is proposed incorporating EGJ and esophageal motor findings, and contraction reserve on provocative tests during HRM.

Measurement of manometric pressures in the upper gastrointestinal tract has been done for the past 40 years. Although extensive amounts of data have been compiled for the lower esophageal sphincter and the esophageal body, technical problems have limited the usefulness of measurements of the upper esophageal sphincter and the pharynx. Newer equipment and methods may solve these technical problems, but more normative data and more widespread use of these technologies must be obtained before manometry is clinically useful in the diagnosis of pharyngeal dysphagia.