Human upper esophageal sphincter pressure profile

Abstract

The pressure profile of the upper esophageal sphincter was characterized in nine normal subjects. Directionally oriented intraluminal pressures were recorded, at 0.5-cm intervals over a 6-cm segment that encompassed the sphincter, by a high-fidelity low-compliance recording system. The peak resting pressure was directed posteriorly, and the lowest pressures were recorded from the lateral orientations. Significant axial asymmetry was observed with peak posterior pressure 0.55 cm more distal than the anterior pressure. Calculations of variability of pressures recorded at each interval showed the peak pressure to be the most reproducible measurement for each subject. Isotonic saline and acid infusions into the esophagus distal to the sphincter resulted in increased sphincteric peak resting pressure (acid greater than saline). There was axial lengthening of the sphincteric pressure zone with infusion of acid and saline, but this observed increase in length was not significant except at the 50 mmHg level. Pressure profiles recorded during 0.5-cm station pull-throughs were virtually identical to those obtained by a rapid continuous pull-through technique.

Effects of Age on Esophageal Motility: Use of High-resolution Esophageal Impedance Manometry

“…The role of the UES is to prevent entry of air into the digestive tract, to prevent the reflux of material from the esophagus into the pharynx when swallowing, and to allow the release of intraesophageal material when belching or vomiting. [28][29][30][31][32] Effects of aging on UES contraction are not certain so far. There was a report that a significant inverse relation was found between age and resting UES pressure, and time from peak of pharyngeal contraction to UES nadir in 10 healthy elderly was significantly shorter than those of 10 younger adults using conventional manometry.…”

Proposed Catheter Standards for Pharyngeal Manofluorography (Videomanometry)

“…The answer to which is ''best'' is not supported by clinical studies or our personal experience. The work of Kahrilas et al [8] and Gerhardt et al [35] suggests that an appropriate compromise would be to raise the McConnel cricopharyngeal sensor 0.5 to 1 cm in normal persons.…”

“…Lastly, the catheter should have a slightly ovoid shape to help maintain a constant radial orientation. This is important only for unidirectional sensors, since the radial pressures in the pharynx are asymmetrical [25,35].…”

The use of intraluminal manometry to assess upper esophageal sphincter function

“…However, rapid stimulation of a large portion of the esophagus, as occurs with gastroesophageal gas reflux or injection of air into the esophagus, results in inhibition of sphincter tone [23]. Contrary to earlier reports [16,29], more recent studies [28,30,31] have shown that esophageal acidification does not increase UES tone independent of the esophageal distension produced by the infused acid volume. UES tone is diminished during sleep [30] and anesthesia [1, 2,14].…”

“…Radially oriented manometric probes record higher pressures in the anterior and posterior directions than laterally [29,40,41]. Additionally, the longitudinal variation in pressure has a steep gradient, such that the region where pressure is >50% of maximal pressure lies within a 1-cm span [4].…”