Biomechanical and sensory parameters of the human esophagus at four levels

Patel, Rig S.; Rao, Satish S.C.

doi:10.1152/ajpgi.1998.275.2.g187

Cited by 57 publications

(75 citation statements)

References 12 publications

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“…The present technique has its basis in the concepts developed by Biancani et al (3) showing an advancement on the basic manometric technique by measuring pressure in the sphincter using different probe diameters. A preliminary use of impedance planimetry to measure CSA in the EGJ was considered by Patel et al (25). However, keeping the balloon in position at higher pressures proved difficult with a spherical-shaped balloon, and, although a narrowing of the lower esophageal region was observed, it would have been difficult to determine whether the CSA was measured at the optimal position.…”

Section: Discussionmentioning

confidence: 99%

The functional lumen imaging probe (FLIP) for evaluation of the esophagogastric junction

McMahon

Frøkjær²,

Kunwald³

et al. 2007

American Journal of Physiology-Gastrointestinal and Liver Physi

133

136

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P, Drewes AM, Gregersen H. The functional lumen imaging probe (FLIP) for evaluation of the esophagogastric junction. Am J Physiol Gastrointest Liver Physiol 292: G377-G384, 2007. First published August 31, 2006; doi:10.1152/ajpgi.00311.2006.-There is a need for new methods to study the dynamics of the esophagogastric junction (EGJ). The aims were to verify the efficacy and usefulness of a "functional lumen imaging probe" (FLIP) for the evaluation of the EGJ. Eight healthy volunteers (6 men), median age 26 (21-35) yr, and two achalasia patients underwent the FLIP procedure. The EGJ was located by manometry. The FLIP measured eight cross-sectional areas (CSAs) 4 mm apart together with the pressure inside a saline-filled cylindrical bag. The data showed the geometric profile of the EGJ reconstructed in a video animation of its dynamic activity. A plot of curve-fitted data for the smallest CSA vs. pressure after balloon distension indicated that the pressure increased from 18 cmH 2O at a CSA of 38 mm 2 to a pressure of 37 cmH2O at a CSA of 230 mm 2 for the healthy controls. In one achalasia patient (unsuccessfully treated with dilations), the CSA never rose above the minimal measurable value despite the pressure increasing to 50 cmH2O. In another achalasia patient (successfully treated with dilations), the pressure only reached 15 cmH2O despite opening to a CSA of 250 mm 2 . In conclusion, FLIP represents the first dynamic technique to profile the function and anatomy of the EGJ. The method can be used practically to evaluate difficult cases of EGJ dysfunction and may provide a role in evaluating patients before and after therapies for diseases affecting the EGJ such as achalasia and gastroesophageal reflux disease. esophagus; competence; distensibility; cross-sectional area; functional imaging THE LOWER ESOPHAGEAL SPHINCTER (LES) is not solely responsible for impeding the flow between the esophagus and the stomach. The crural diaphragm encircles ϳ2 cm of the esophagogastric junction (EGJ), and the sling or oblique fibers of the stomach also contribute to the mechanism (15, 21). Esophageal and gastric motility, pressures in the abdominal and thoracic cavities, and the exact location of the EGJ all play a role in defining its function. The anatomy and behavior of the EGJ also change with time and body posture (20). The EGJ is a very dynamic mechanical structure. A lot of knowledge about the anatomy of the EGJ has been assembled over the last 40 years, but much of our limited understanding of the behavior has been related to manometric studies. Intraluminal pressure recording is the current gold standard for determining the motility characteristics of the esophagus. Although manometry provides useful information on the location of the EGJ and on phasic motility within the lumens of the digestive tract, it may be more restrictive in what it can tell us about sphincteric regions and their dynamics.Two classic diseases involving the EGJ are gastroesophageal reflux disease (GERD) and achalasia. Achalasia is an esophageal ...

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Section: Discussionmentioning

confidence: 99%

The functional lumen imaging probe (FLIP) for evaluation of the esophagogastric junction

McMahon

Frøkjær²,

Kunwald³

et al. 2007

American Journal of Physiology-Gastrointestinal and Liver Physi

133

136

View full text Add to dashboard Cite

show abstract

“…Patients however, are often older. Second, Patel et al [34] among others have demonstrated that sensory thresholds to distension are higher proximally than distally in the esophagus. We chose to position the probe so that the bag stimulated 8 cm above the EGJ, and current was delivered proximally 20 cm above the EGJ.…”

Section: External Validitymentioning

confidence: 98%

The Esophageal Multimodal Pain Model: Normal Values and Degree of Sensitization in Healthy Young Male Volunteers

et al. 2011

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“…Other studies have shown that elderly patients presented with lower amplitude of contractions in the distal esophagus and lower number of complete relaxation of the LES (12,13,20) . Recent studies in the elderly show that both the sensory function, and visceral perception were significantly decreased with advanced age (15,17,18,22) . Despite all these findings, few studies were done to investigate the effect of age on esophageal motility of patients with achalasia.…”

Section: Resultsmentioning

confidence: 99%

“…In our study younger people were more symptomatic than the elderly. It has been demonstrated (15,17,18,22) that with age there is loss of the sensory function of the esophagus, with lower perception of symptoms. Some studies have confirmed this finding by means of esophageal balloon distention.…”

Section: -Jan/mar 2011mentioning

confidence: 99%

Achalasia in the elderly patient: a comparative study

Schechter

Lemme

Novais

et al. 2011

Arq. Gastroenterol.

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-Context -Achalasia is a primary esophageal motor disorder secondary to the degeneration of ganglion cells of the inhibitory intramural myenteric plexus. It affects both sexes similarly and has two peaks of incidence, one in the 3rd to 4th decades of life and the other after 60 years of age. The effect of age on esophageal motility of patients with achalasia is not well known. Studies have shown that healthy older people, when compared to the young, have: a) a lower number of ganglion cells in the intramural myenteric plexus; b) a reduced normal relaxation of the lower esophageal sphincter; and c) a reduced esophageal peristalsis. Thus, as both age and achalasia can produce comparable degenerative changes in the intramural myenteric plexus, it is possible that advanced age could be an important factor in enhancing the clinical and manometric abnormalities commonly found in patients with achalasia. Objectives -To compare the clinical, radiological and manometric findings in young as compared to elderly (>60 years old) achalasia patients. Methods -A retrospective study of a group of patients with untreated achalasia separated into young and elderly patients. Demographic, clinical, serology for Chagas' disease, radiological and manometric data were compared between these groups. The level of significance was P<0.05. Results -The study included 105 patients, 52 young (25 M/27 F, mean age 40 years old) and 53 elderly (21 M/32 F, mean age 70 years old). The elderly group had a higher prevalence of Chagas' disease (P = 0.004) and a lower pressure of the lower esophageal sphincter [26.4 mm Hg vs 31.9 mm Hg] P = 0.001, a difference that persisted when analyzed only elderly and young patients with idiopathic achalasia. Younger patients had a higher prevalence of heartburn (P = 0.001) and chest pain (P = 0.012) than the elderly. Conclusion -Elderly patients with achalasia had a lower esophageal sphincter pressure than the young, even when we excluded patients with Chagas' disease but, as a group, they were less symptomatic. HEADINGS -Esophageal achalasia. Aged. Manometry.

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Biomechanical and sensory parameters of the human esophagus at four levels

Cited by 57 publications

References 12 publications

The functional lumen imaging probe (FLIP) for evaluation of the esophagogastric junction

The functional lumen imaging probe (FLIP) for evaluation of the esophagogastric junction

The Esophageal Multimodal Pain Model: Normal Values and Degree of Sensitization in Healthy Young Male Volunteers

Achalasia in the elderly patient: a comparative study

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