Assessment of oesophageal motor function using combined perfusion manometry and multi‐channel intra‐luminal impedance measurement in normal subjects

Abstract

Multichannel intraluminal impedance (MII) is being used increasingly to assess oesophageal bolus clearance. However, there is no good standardization of the impedance parameters that define 'effective bolus clearance'. The aim of this study was to define these important impedance parameters and to determine their normal values. Concurrent perfusion manometry and MII were performed in 42 healthy volunteers. Ten, 5-mL liquid (saline) boluses and then, 10x5-mL low impedance viscous boluses were tested in each subject in the right-lateral position. Normal values for bolus presence time (BPT) at each site and total bolus transit time (TBTT) were determined from either 'normal' peristaltic responses (amplitude>or=30 mmHg in distal oesophagus) or 'super-normal' peristaltic responses (amplitudes>or=50 mmHg at all sites). The relationship between BPT and TBTT within a response and per-individual performance was determined. A total of 840 swallows of liquids and viscous responses were analysed. BPT and TBTT of viscous swallows were longer than those for liquids. Non-peristaltic responses were significantly more likely not to clear a viscous than a liquid bolus. Within a response, the number of sites with prolonged BPT strongly predicted the incidence of prolonged TBTT. Using impedance criteria, normal oesophageal bolus clearance is defined when an individual completely clears at least 70% of liquid responses and at least 60% of viscous responses. This study provides normal values for impedance measurement of bolus clearance when combined with perfusion manometry. These values will allow standardization of impedance application in oesophageal function testing, in both research and clinical setting.

Evaluation of esophageal motility and reflux in children treated for esophageal atresia with the use of combined multichannel intraluminal impedance and pH monitoring

“…The evaluation of esophageal motility using only MII is supported by comparative studies with manometry and fluoroscopy. The contraction wave seen on impedance is correlated with the maximal pressure produced during simultaneous manometry, and the bolus entry, transit, and exit with respect to the measuring segment have been correlated with simultaneous barium swallow [12,[28][29][30][31][32].…”

Impedance technology for the management of esophageal disorders

“…3. These values were later confirmed by a Dutch-Australian multicenter study in 42 healthy volunteers using combined water-perfused manometry-impedance systems [9]. A third set of normal data for combined impedance-manometry testing was reported by Nguyen et al in a group of 25 healthy subjects [10].…”

New technologies in the gastrointestinal clinic and research: Impedance and high-resolution manometry

“…Their results revealed that total bolus transit time for both liquid and viscous swallows were 12.5 s and greater than 90% of individuals had > 80% of the liquid swallows associated with complete bolus transit and > 70% of the viscous swallows associated with complete bolus transit [10] . Two other studies in normal controls revealed similar bolus transit parameters and thus, it appears that this technology is reproducible in normal subjects [11,12] .…”