Search

We determined whether an abbreviated motility study that is commonly employed in clinical esophageal manometrics was as accurate as an extended manometric evaluation in detecting abnormalities in the esophageal body. One hundred patients underwent both abbreviated (stationary catheter, 10 wet swallows) and extended manometries (stepwise catheter withdrawal, 62 +/- 1 wet swallows). Classification by the two techniques was identical in 83 patients. Abbreviated manometry failed to recognize nine abnormal motility patterns. The abbreviated method was least accurate in the identification of intermittent and focal motility abnormalities (sensitivity = 0.50). Misclassifications were related to catheter position and not solely to differences in the total number of swallows. Of the individual wave parameters measured by each method, detection of multipeaked contraction waves was the most discrepant (R = 0.59). These findings indicate that abbreviated esophageal manometry is reasonably well correlated with a more extended method in detecting esophageal motility disorders and, because of its relative simplicity, appears appropriate for use in clinical practice. Errors related to stationary recording port positions may interfere with the overall accuracy of the abbreviated technique.

SummaryTransverse muscle strips were cut from four segments of the opossum esophagus. Segment I was the segment of smooth muscle bordering on the striated muscle proximally and Segment IV was the distal segment which includes the lower esophageal sphincter. Segments II and III were the two central fourths of the smooth muscle esophagus. The tissue calcium content was determined in strips coming from the four segments after ashing and extraction of strips in concentrated HCl-HNO3. The calcium content (in mmole/kg wet muscle ± 1 SE) was 2.70 ± 0.1 in Segment I, 2.8 ± 0.3 in Segment II, 2.6 ± 0.3 in Segment III, and 2.6 ± 0.3 in Segment IV after 2 hr of incubation.After incubation of strips coming from the four segments, efflux of 45Ca was measured during 15 two-min periods. Efflux was rapid at first with a halftime of 5 min and slowed after three periods to a halftime of 29 min. In all nine animals tested, efflux from the lower esophageal sphincter was slower than that from muscle of the esophageal body. Th...

When a perforation of the esophagus is due to diagnostic or therapeutic procedures, it is called iatrogenic.

The original objective of our studies was prospectively to determine the efficacy, durability, and complications of Nissen’s fundoplication (FUN) alone, or combined with lengthening gastroplasty (FUN-GP, Collis-Nissen), in patients with complicated reflux esophagitis failing medical therapy. This brief report emphasizes the incidence, nature, and duration of a particular postoperative complication — esophageal aperistalsis.

Pressure recordings in the esophageal body, LES and stomach were performed in 10 healthy subjects before and after caloric stimulation of the labyrinth. While esophageal and stomach responses varied or were absent, all subjects showed variations at the LES level. Duration of LES relaxation was increased and both time and amplitude of LES augmentation were significantly reduced. The physiological mechanism of labyrinthine-digestive connections and the possibility of clinical applications are discussed.

The antireflux mechanism in man consists of the esophageal body — a pump, the distal esophageal sphincter — a valve, and the stomach — a reservoir. Abnormalities in any of these components of the antireflux mechanism can be responsible for increased esophageal acid exposure, the basic abnormality of gastroesophageal reflux disease.

The esophagus may be regarded as a tube extending from pharynx to stomach and serving for transport of material between these two organs. At rest (i.e., between swallows and regurgitations), sphincter mechanisms at either end of the tube prevent easy access of air from above and gastric contents from below. For purposes of clarity the control of the tubular esophagus (or esophageal body) and that of the sphincter areas will be dealt with separately.

Esophageal manometry gives us information about motihty in the body of the esophagus and the tone and function of the lower esophageal sphincter. Are there manometric differences between patients with gastroesophageal reflux disease (GERD) with an esophagus-lined normally with squamous mucosa and patients with GERD who have an esophagus partly hned with columnar mucosa (Barrett’s esophagus).

Palliative exclusion of the esophagus by use of transposed stomach was performed in a 63-year-old woman with unresectable cervical esophageal cancer. Twelve weeks after this operation, motor function of the excluded esophagus was assessed. All voluntary swallows produced a motor response in the esophageal body. Eighty-five per cent of the contractions were peristaltic and generated mean pressures of 28 mmHg. Fifteen per cent of the deglutitions were followed by nonpropulsive waves with mean pressures of 24 mmHg. Spontaneous tertiary activity occurred at a rate of 2.5 contractions per minute with an amplitude of 16 mmHg. Motor function in the excluded esophagus persists after bypass of the organ. This suggests that the excluded esophagus should be decompressed after surgery to prevent "blowout" of its closed ends.

Recent studies indicate that lower esophageal sphincter pressure is influenced by manometric assembly diameter. This study determines the effect of assembly diameter on both esophageal sphincter pressure and peristaltic pressure in the esophageal body. We performed esophageal manometric studies in 6 normal subjects using graded assembly diameters. High-fidelity recording was achieved by using a noncompliant catheter-infusion system. The results indicate that increases in assembly diameter cause significant increases in peristaltic pressure amplitudes and in resting sphincter pressure in both the smooth and striated muscle portions of the esophagus. This phenomenon is best explained by the length-tension characteristics of esophageal muscle, increased stretch causing greater contraction force.

We tested a manometric assembly employing a sleeve sensor that is able to monitor anterior or posterior pressure in the human upper esophageal sphincter (UES) for prolonged intervals. When compared to rapid pull-through measurement of UES pressure obtained with conventional manometric assemblies, the sleeve sensor measured significantly lower UES pressures with less variability between subjects, thereby suggesting that the rapid pull-through maneuver stimulates the UES to contract. Concurrent recordings of UES pressure with a sleeve sensor and a side-hole sensor during a slow station pull-through yielded almost equal pressure values at the peak of the high-pressure zone (station zero), but the side-hole site recorded significantly lower pressures than the sleeve at stations 0.5 cm or more from the peak of the high-pressure zone. During 10 min of recording at station zero, the sleeve sensor recorded greater pressures than the side-hole sensor. This finding demonstrated the suceptibility of the side-hole sensor to axial movement relative to peak UES pressure. When stationary, both the sleeve sensor and the side-hole sensor recorded significantly lower UES pressure after 1–2 min of recording, again suggesting that movement of the recording assembly stimulates the UES to contract. Sleeve recordings of swallow-induced UES relaxations showed that UES relaxations induced by water swallows were slightly longer than those induced by dry swallows. Augmentations of UES pressure induced by balloon distension of the esophageal body were also recorded. We conclude that the sleeve sensor is a suitable method for investigating the normal physiology and pathophysiology of the UES in human subjects.

Gastroesophageal reflux is a common problem in premature infants. The aim of this study was to use a novel manometric technique to measure esophageal body and lower esophageal sphincter pressures in premature infants.Micromanometric feeding assemblies (OD,or = 2 mm) incorporating 4-9 manometric channels were used in 49 studies of 27 premature neonates. Esophageal body motility was recorded at three sites for 20 minutes after feeding. Twenty attempts (one per minute) were made to stimulate swallowing via facial stimulation (Santmyer reflex). In 32 studies lower esophageal sphincter pressures were recorded (sleeve) for 15 minutes before and after feeding.Peristaltic motor patterns were less common than non-peristaltic motor patterns (26.6% vs. 73.4%; P0.0001) that comprised 31.1% synchronous, 34.6% incomplete, and 6.3% retrograde pressure waves. Reflex swallowing was elicited more frequently in neonates older than 34 weeks postconceptional age than in younger infants (33.4% vs. 20.4%; P0.05). Mean lower esophageal sphincter pressure was 20.5 +/- 1.7 mm Hg before and 13.7 +/- 1.3 mm Hg after feeding (P0.0005).Premature infants show nonperistaltic esophageal motility that may contribute to poor clearance of refluxed material. In contrast, the lower esophageal sphincter mechanisms seem well developed.

The clinical case of a 14-month-old girl with esophageal achalasia is described. Manometry revealed aperistalsis throughout the esophageal body and impaired relaxation of the lower esophageal sphincter. Six months after Heller's myotomy, manometric examination of the esophagus showed the return of peristalsis.

Background and Aims: Perfused miniature manometric assemblies with lumina of 0.4-0.5 mm i.d. have been developed. Reduced luminal size offers the advantages of reduced assembly bulk and increased assembly complexity with greater numbers of lumina and lower manometric infusion volumes because of a slower perfusion rate. This study investigated the recording fidelity of miniature manometric assemblies in the measurement of esophageal peristalsis. Methods: Four miniature manometric assemblies, each containing manometric lumina of either 0.4 or 0.5 mm i.d., were evaluated at 100 and 180 cm lengths. The fidelity of miniature manometric luminal recordings were evaluated in vivo during esophageal peristalsis by using a simultaneous comparison with the standard lumina and an intraluminal strain gauge. Results: During esophageal peristalsis, miniature manometric lumina recorded the peak amplitude of pressure waves, with an accuracy at perfusion rates of 0.04 mL/min (0.4 mm, i.d) and 0.15 mL/min (0.5 mm, i.d.). Conclusion: Miniature manometric assemblies of lengths that are practical for use in humans are suitable for recording esophageal peristalsis.

Udgivelsesdato: 1990-Mar Isolated smooth muscle strips from the human esophagus representing both the longitudinal and circular layers of the esophagogastric junction and the esophageal body were prepared. The strips were mounted in organ baths, and resting length was defined. By repeatedly increasing the length of the strips with 20% of resting length and recording values of resting and active tensions, length-tension relations for each muscle type were constructed. Only circular strips from the esophagogastric junction developed active, resting tension, disclosed by replacing the normal Ca2(+)-containing Krebs solution with Ca2(+)-free medium. Carbachol (10(-6) M) was used for submaximal activation of the contractile apparatus. At lengths between 180 and 260% of resting length, all strips reached optimum length (LO) where further elongation gave no further increase in active tension development. Repeated stimulations with carbachol was possible at a length of 200% of LO without affecting reproducibility. Determination of different collagen components revealed no differences between muscle types.

Strips of smooth muscle, cut transversely from the smooth-muscle segment of opossum esophagus, were superfused with oxygenated Krebs-Ringer solution at 37 degrees C in a system that allowed electrical field stimulation of the intrinsic nerves. Three-to-five-second trains of rectangular pulses (0.5 ms long at 10 Hz) were delivered at 30-s intervals at supramaximal maximal current strength. In strips from the esophageal body, each train resulted in a twitch which followed after the end of train with a particular latency, the off-response. Strips from the esophagogastric sphincter relaxed during the train. Temperature was varied above and below 37 degrees C to observe the temperature dependence of the responses. Latency of the off-response varied exponentially with temperature. Amplitude of the off-response showed a linear decline with changes in temperature, both above and below 35 degrees C, the zero-intercepts being 19.6 and 42.3 degrees C, respectively. Amplitude of relaxation of strips from the junction varied little between 20 and 37 degree C but declined sharply beyond those limits, the zero-intercepts being 14.2 and 42 degrees C, respectively.