Functional testing: pharyngeal pH monitoring and high‐resolution manometry

Savarino, Edoardo; Zentilin, Patrizia; Savarino, Vincenzo; Tenca, Andrea; Penagini, Roberto; Clarke, John O.; Bravi, I.; Zerbib, Frank; Yüksel, Elif Sarıtaş

doi:10.1111/nyas.12255

Cited by 13 publications

(7 citation statements)

References 46 publications

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“…Thus, esophageal diseases are a substantial burden in Western countries, and this is the reason for a continuous search and development of new diagnostic modalities able to overcome the limitations of the existing ones . Indeed, white‐light endoscopy has shown partial accuracy for the diagnosis of GERD and its complications, because the majority of GERD patients have normal endoscopy . Radiological methods have only an ancillary place in some motor disorders of the esophagus, as they do not have any role in the diagnosis of GERD.…”

Section: Introductionmentioning

confidence: 99%

“…2,4 Indeed, white-light endoscopy has shown partial accuracy for the diagnosis of GERD and its complications, because the majority of GERD patients have normal doi: 10.1111/nyas.13255 endoscopy. 3,5,6 Radiological methods have only an ancillary place in some motor disorders of the esophagus, as they do not have any role in the diagnosis of GERD. Although imaging methods, such as computed tomography (CT) and positron emission tomography (PET), have established roles in staging malignant disorders, their utility in finding late-stage disease may be better targeted in the future using novel methods of patient selection to enhance diagnostic yield by avoiding imaging in patients unlikely to have advanced disease.…”

Section: Introductionmentioning

confidence: 99%

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Novel insights into esophageal diagnostic procedures

Savarino

Ottonello

Tolone

et al. 2016

Annals of the New York Academy of Sciences

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The 21st century offers new advances in diagnostic procedures and protocols in the management of esophageal diseases. This review highlights the most recent advances in esophageal diagnostic technologies, including clinical applications of novel endoscopic devices, such as ultrathin endoscopy and confocal laser endomicroscopy for diagnosis and management of Barrett's esophagus; novel parameters and protocols in high-resolution esophageal manometry for the identification and better classification of motility abnormalities; innovative connections between esophageal motility disorder diagnosis and detection of gastroesophageal reflux disease (GERD); impedance-pH testing for detecting the various GERD phenotypes; performance of distensibility testing for better pathophysiological knowledge of the esophagus and other gastrointestinal abnormalities; and a modern view of positron emission tomography scanning in metastatic disease detection in the era of accountability as a model for examining other new technologies. We now have better tools than ever for the detection of esophageal diseases and disorders, and emerging data are helping to define how well these tools change management and provide value to clinicians. This review features novel insights from multidisciplinary perspectives, including both surgical and medical perspectives, into these new tools, and it offers guidance on the use of novel technologies in clinical practice and future directions for research.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Novel insights into esophageal diagnostic procedures

Savarino

Ottonello

Tolone

et al. 2016

Annals of the New York Academy of Sciences

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“…In particular, the pharyngeal swallowing process is assessed to detect any pooling in the pyriform sinus or valleculae, and aspiration [ 2 ]. In addition to these functional assessments, pharyngeal pressure changes are assessed using manometry [ 3 4 5 ]. In the conventional manometric procedure, subjects experience discomfort due to the overly thick catheter, and the lack of sensors makes it difficult to observe the results for a specific area.…”

Section: Introductionmentioning

confidence: 99%

Effects of Head Rotation and Head Tilt on Pharyngeal Pressure Events Using High Resolution Manometry

et al. 2015

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ObjectiveTo observe changes in pharyngeal pressure during the swallowing process according to postures in normal individuals using high-resolution manometry (HRM).MethodsTen healthy volunteers drank 5 mL of water twice while sitting in a neutral posture. Thereafter, they drank the same amount of water twice in the head rotation and head tilting postures. The pressure and time during the deglutition process for each posture were measured with HRM. The data obtained for these two postures were compared with those obtained from the neutral posture.ResultsThe maximum pressure, area, rise time, and duration in velopharynx (VP) and tongue base (TB) were not affected by changes in posture. In comparison, the maximum pressure and the pre-upper esophageal sphincter (UES) maximum pressure of the lower pharynx in the counter-catheter head rotation posture were lower than those in the neutral posture. The lower pharynx pressure in the catheter head tilting posture was higher than that in the counter-catheter head tilting. The changes in the VP peak and epiglottis, VP and TB peaks, and the VP onset and post-UES time intervals were significant in head tilting and head rotation toward the catheter postures, as compared with neutral posture.ConclusionThe pharyngeal pressure and time parameter analysis using HRM determined the availability of head rotation as a compensatory technique for safe swallowing. Tilting the head smoothes the progress of food by increasing the pressure in the pharynx.

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“…This sensor detects aerosolized or liquid acid, records pH values twice every second (2 Hz) while other pH devices may detect pH values once every 4-6 seconds. The device utilizes a 1.5 mm diameter catheter that incorporates a flashing LED light at its tip to facilitate placement [6,7]. Data is sent from the probe to a wireless recording device and saved to an SD card for latter download and analysis.…”

Section: Interventionmentioning

confidence: 99%

Documenting the Hypopharyngeal Environment of Patients Undergoing General Endotracheal Tube Anesthesia: A First Look at Intraoperative pH Characteristics

Regenbogen¹

2015

Otolaryngol (Sunnyvale)

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OtolaryngologyOto la ry n g ol ogy: Op en A c ce ss ISSN: 2161-119XRegenbogen et al., Otolaryngology 2015, 5 AbstractObjectives: While laryngeal injuries are important and not infrequent following both short and extended endotracheal tube exposure, little detailed information is available regarding the hypopharyngeal environment during intubation. The objective of this pilot study was to explore a simple method of accurately documenting hypopharyngeal pH values in surgical patients undergoing endotracheal tube anesthesia and to report the findings.Methods: Twenty volunteers were continuously monitored intra-operatively using a commercially available hypopharyngeal pH monitoring system. Demographics, pre-and postoperative voice and reflux self reported survey data were also collected. Results:No complications associated with the pH monitoring system occurred. Median pH was 6.5 (range 6.0-7.0); median recorded time in minutes was 183.9 (range 130.7 -323.5). 13/20 patients had pH>5.0 ≤ 5.5 events, for up to 113 minutes of monitored time; 2/20 patients had pH>4.0 ≤ 5.0 events, for up to 8 minutes of monitored time; 2/20 patients had pH ≤ 4.0 events, for up to 61 minutes of monitored time. Conclusions:The hypopharyngeal pH test was used successfully to intra-operatively record hypopharyngeal pH variations. Extended pharyngeal exposures to low pH environments were commonly documented. No associations were found with patient survey scores. Future research appears warranted to expand this study, identify "at-risk" populations and to rigorously evaluate an expanded set of voice-related and lower airway clinical outcomes measures.

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Functional testing: pharyngeal pH monitoring and high‐resolution manometry

Cited by 13 publications

References 46 publications

Novel insights into esophageal diagnostic procedures

Novel insights into esophageal diagnostic procedures

Effects of Head Rotation and Head Tilt on Pharyngeal Pressure Events Using High Resolution Manometry

Documenting the Hypopharyngeal Environment of Patients Undergoing General Endotracheal Tube Anesthesia: A First Look at Intraoperative pH Characteristics

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