Esophageal body length, lower esophageal sphincter length, position and pressure in health and disease

Abstract

We compared esophageal dimensions in control subjects and patients with differing motility disorders and severities of reflux disease. Patients (1108) and healthy controls (36) underwent manometry and 24-h pH monitoring. Subjects were grouped according to pH and manometry data into seven groups. Mean (s.e.m.) esophageal body length is greatest in achalasia [22.41 (0.27) cm] and least in reflux disease [20.06 (0.13) cm, p < 0.05]. Lower esophageal sphincter (LES) pressure is greatest in achalasia [17.46 (1.06) mmHg] and least in reflux disease [6.57 (0.24) mmHg, p < 0.05]. LES length is least in achalasia patients and control subjects. The ratio of intra-abdominal to intrathoracic LES is greatest in achalasia (1.29), no reflux and normal motility group, and controls and least in reflux disease (1.04, p < 0.05). In conclusion, esophageal body length is greatest in achalasia and least in reflux disease. This is associated with caudal movement of the LES in achalasia and cranial movement of the LES in reflux disease, relative to the diaphragm.

A High-resolution View of Achalasia

“…27 Several previous studies showed that the esophagus is significantly longer in achalasia patients than in those with other esophageal motility disorders or normal subjects. [29][30][31] Using HRM to measure esophageal length, we could not confirm these observations. Another typical, but not diagnostic feature of achalasia is swallow-induced repetitive, isobaric esophageal pressure waves seen in the smooth muscle portion of the esophagus (Fig.…”

Double probe pH-monitoring findings in patients with benign lesions of the true vocal folds: comparison with typical GERD and the effect of smoking

“…Since the mean esophageal length (i.e. the distance between the upper and lower esophageal sphincter) has been calculated at 21.93 (0.33) cm [21], the proximal probe would be expected to be above the UES in [99% of cases. Manometry confirmed that the upper probe was above the UES in all the patients of this study.…”

The Transnasal Esophagoscopy Documentation Dilemma

“…Unfortunately, the historic standard reporting measure for esophagoscopy does not apply to the newer transnasal insertion route, which should more accurately be recorded in centimeters from the nares. One anecdotal report in the literature that attempts to address this issue is based on expert opinion and deals with esophageal manometry rather than esophagoscopy 8,9 . The anatomic length difference between the nasal and oral aerodigestive system has been estimated to be between 3 and 5 cm 8–10 .…”

“…One anecdotal report in the literature that attempts to address this issue is based on expert opinion and deals with esophageal manometry rather than esophagoscopy 8,9 . The anatomic length difference between the nasal and oral aerodigestive system has been estimated to be between 3 and 5 cm 8–10 . The goal of this project is to directly measure the difference to clarify the existing standardization and documentation dilemma.…”