Anatomophysiology of the Pharyngo-Upper Esophageal Area in Light of High-Resolution Manometry

Silva, Luciana C.; Herbella, Fernando A. M.; Neves, Luciano Rodrigues; Vicentine, Fernando Pompeu Piza; Neto, Sebastião Pannocchia; Patti, Marco G.

doi:10.1007/s11605-013-2358-3

Cited by 32 publications

(25 citation statements)

References 21 publications

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“…Pharyngo-esophagogastric function refers to the coordinated pharyngeal and upper esophageal relaxation during swallowing, the manometric reflection of the activity of the striated muscles of the pharynx and cervical esophagus. Although the distal upper gastrointestinal tract consists of smooth muscles, the UES correlates with striated muscle physiology [ 11 ]. Three-dimensional HRM study of the UES, mainly in healthy patients, revealed a significant variance of UES characteristics and confirmed the asymmetrical pharyngeal anatomy [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…More precisely, mean UES resting pressure, length and mean UES residual pressure are calculated. Lately, there have been a few publications proposing normal values for the pharynx and the UES function in asymptomatic patients [ 11 - 14 ]. Herein, abnormalities such as incomplete relaxation, cricopharyngeal bar, elevated baseline pressure or discoordination between the pharynx and the proximal esophagus may be detected [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

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Can the upper esophageal sphincter contractile integral help classify achalasia?

Triantafyllou¹

2018

aog

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Background:The use of high-resolution manometry (HRM) in achalasia patients has revealed abnormal findings concerning upper esophageal sphincter (UES) function. The introduction of the UES contractile integral (UES-CI), as with the distal contractile integral (DCI), may complement the interpretation of the manometric study of achalasia subtypes, defined by the Chicago Classification v3.0.Methods:Patients were classified into achalasia subtypes based on HRM. UES length (cm), UES resting pressure (mmHg), and UES residual pressure (mmHg) were recorded. UES-CI (mmHg·sec·cm) was calculated in a manner similar to that used for the DCI measurement at rest (landmark CI), corrected for respiration, and its relation to achalasia subtypes was evaluated.Results:Twenty-four achalasia patients with mean age 55.29 years were included. Of these, 16.6% (n=4) were diagnosed with achalasia type I, 58.3% (n=14) with type II, and 25% (n=6) with type III. The landmark UES-CI, mean UES-CI, UES-CI corrected for respiration, and UES resting pressure were found to be significantly higher among patients with achalasia type II compared to the other types (1768.9 vs. 677.1, P=0.03; 1827.1 vs. 3555.1, P=0.036; 174.2 vs. 72.8, P=0.027; and 108.1 vs. 55.8, P=0.009, respectively).Conclusions:We introduce the CI index as a tool for the manometric evaluation of the UES in achalasia. UES resting pressure, landmark UES-CI and mean UES-CI were significantly higher in achalasia patients with panesophageal pressurization compared to types I and III. This finding may reflect a protective reaction against the risk of aspiration in this group, but further studying and clinical correlation is required.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Can the upper esophageal sphincter contractile integral help classify achalasia?

Triantafyllou¹

2018

aog

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“…Thus, extreme values as 19 and 165 may be considered normal 3 . Other groups showed a normal range varying from 35 to 113 9 , 10 . The wide variation in results can be partly explained by the influence of factors affecting the measurement of the pressure of UES such as the head position 7 or age of the patients 4 .…”

Section: Discussionmentioning

confidence: 96%

Upper esophageal sphincter resting pressure varies during esophageal manometry

Rezende

Herbella

Silva

et al. 2014

ABCD, arq. bras. cir. dig.

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BackgroundThe 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.AimTo evaluate the variation of the resting pressure of the upper esophageal sphincter during high resolution manometry.MethodsWas 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.ResultsThe 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.ConclusionA 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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“…UES boundary and transitional zone (which distinguishes proximal and distal esophagus) were defined using 30‐mmHg isobaric contour tool. Proximal contractile integral was adopted to assess the function of the skeletal muscle and was defined as the product of length, time, and contractile amplitude above a threshold of 20 mmHg . Other metrics including integrated relaxation pressure and motor diagnosis were measured as described in Chicago Classification 3.0.…”

Section: Methodsmentioning

confidence: 99%

A study of proximal esophageal baseline impedance in identifying and predicting laryngopharyngeal reflux

Chen

Liang

Zhang

et al. 2020

J of Gastro and Hepatol

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Background and Aim: Laryngopharyngeal reflux (LPR) is caused by the reflux of gastric contents beyond the esophagus into the larynx and pharynx. However, upper esophageal sphincter (UES) motility and proximal esophagus reflux parameters are poorly studied. This study aims to explore the characteristics of UES motility and reflux parameter among LPR patients. Methods: Patients with laryngopharyngeal symptoms only (L), patients with laryngopharyngeal symptoms and typical esophageal symptoms (L + E), patients with typical esophageal symptoms only (E), and healthy controls (H) were retrospectively included. Physiological profiles were studied and compared among groups using both high-resolution manometry and pH-impedance monitoring, including UES basal pressure, residual pressure, relaxation duration time, recovery time, the time to nadir pressure, UES length, proximal contractile integral, and proximal mean nocturnal baseline impedance (MNBI). Patients' symptom outcomes were also analyzed. Results: A total of 242 patients were included. Proximal MNBI was significantly lower in patients with both laryngopharyngeal and esophageal symptoms (17 cm above low esophageal sphincter [LES]: L vs L + E vs E vs H = 3689.7 vs 2500.0 vs 3073.0 vs 3996.0; 15 cm above LES: L vs L + E vs E vs H = 3155.9 vs 2553.4 vs 3198.9 vs 2985.2; P < 0.001). Patients responded to proton pump inhibitor treatment also had lower proximal MNBI than those who did not (17 cm above LES: 1834.0 vs 3500.0; 15 cm above LES: 1946.5 vs 3432.6; P < 0.001). Conclusion: Decreased proximal MNBI can not only identify LPR patients but also predict patients' symptom outcomes.

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Anatomophysiology of the Pharyngo-Upper Esophageal Area in Light of High-Resolution Manometry

Abstract: In conclusion, normal values were established. These values may prove clinically useful and could contribute to future studies with dysphagic patients.

Cited by 32 publications

References 21 publications

Can the upper esophageal sphincter contractile integral help classify achalasia?

Can the upper esophageal sphincter contractile integral help classify achalasia?

Upper esophageal sphincter resting pressure varies during esophageal manometry

A study of proximal esophageal baseline impedance in identifying and predicting laryngopharyngeal reflux

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