Impedance characteristics of normal oesophageal motor function

Nguyen, H N; Domingues, Gerson R; Winograd, Ron; Koppitz, P.; Lammert, Frank; Silny, Jiri; Matern, Siegfried

doi:10.1097/01.meg.0000059161.46867.2b

Cited by 28 publications

(5 citation statements)

References 34 publications

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“…Validated normal manometric values for a semi‐solid or solid bolus swallows have not hitherto been defined. Increased viscosity of the bolus is associated with increased wave amplitude and duration, and decreased propagation velocity 15–18 . Although our study did not show any effect of viscosity on wave amplitude, the propagation time of viscous boluses was significantly longer than that of liquids, which correlated with the more prolonged TBTT of viscous boluses.…”

Section: Discussioncontrasting

confidence: 68%

“…Increased viscosity of the bolus is associated with increased wave amplitude and duration, and decreased propagation velocity. [15][16][17][18] Although our study did not show any effect of viscosity on wave amplitude, the propagation time of viscous boluses was significantly longer than that of liquids, which correlated with the more prolonged TBTT of viscous boluses. In the presence of a defective peristaltic response, viscous boluses were more likely to exhibit failed clearance with failed peristalsis and simultaneous responses than were liquids boluses, but had similar rates of impaired clearance with normal or hypotensive responses.…”

Section: Discussionmentioning

confidence: 91%

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

Nguyen

Rigda

Tippett

et al. 2005

Neurogastroenterology Motil

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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.

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Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 91%

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

Nguyen

Rigda

Tippett

et al. 2005

Neurogastroenterology Motil

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“…However, the predictive value of impedance monitoring in assessing bolus transport in symptomatic patients with motility disorders has not been validated so far. Several series have identified normal values for esophageal function testing with impedance monitoring 59–61 . Depending on the series, the lower limit of normal is 70–80% swallows with complete liquid transit or 60–70% swallows with complete viscous bolus transit.…”

Section: Evaluation Of Esophageal Motor Functionmentioning

confidence: 99%

Evaluation of esophageal motor function in clinical practice

Gyawali

Bredenoord

Conklin

et al. 2013

Neurogastroenterology Motil

113

119

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Esophageal motor function is highly coordinated between central and enteric nervous systems and the esophageal musculature, which consists of proximal skeletal and distal smooth muscle in three functional regions, the upper and lower esophageal sphincters, and the esophageal body. While upper endoscopy is useful in evaluating for structural disorders of the esophagus, barium esophagography, radionuclide transit studies, and esophageal intraluminal impedance evaluate esophageal transit and partially assess motor function. However, esophageal manometry is the test of choice for the evaluation of esophageal motor function. In recent years, high-resolution manometry (HRM) has streamlined the process of acquisition and display of esophageal pressure data, while uncovering hitherto unrecognized esophageal physiologic mechanisms and pathophysiologic patterns. New algorithms have been devised for analysis and reporting of esophageal pressure topography from HRM. The clinical value of HRM extends to the pediatric population, and complements preoperative evaluation prior to foregut surgery. Provocative maneuvers during HRM may add to the assessment of esophageal motor function. The addition of impedance to HRM provides bolus transit data, but impact on clinical management remains unclear. Emerging techniques such as 3-D HRM and impedance planimetry show promise in the assessment of esophageal sphincter function and esophageal biomechanics.

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“…As impedance changes are the measure of true bolus transit through the esophagus (as opposed to manometric pressures generated during esophageal contractions), this parameter should be focused on as much as manometry. [19][20][21][22] Few studies incorporated impedance into their upright position analyses. A recent study by Park et al 23 evaluated the effect of upright saline swallows on impedance changes as well as their correlation to peristaltic breaks.…”

Section: Discussionmentioning

confidence: 99%

Improving High-resolution Impedance Manometry Using Novel Viscous and Super-viscous Substrates in the Supine and Upright Positions: A Pilot Study

Wong

Person

Castell

et al. 2018

J Neurogastroenterol Motil

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Background/AimsSwallows with viscous or solid boluses in different body positions alter esophageal manometry patterns. Limitations of previous studies include lack of standardized viscous substrates and the need for chewing prior to swallowing solid boluses. We hypothesize that high-resolution impedance manometry (HRiM) using standardized viscous and super-viscous swallows in supine and upright positions improves sensitivity for detecting esophageal motility abnormalities when compared with traditional saline swallows. To establish normative values for these novel substrates, we recruited healthy volunteers and performed HRiM.MethodsStandardized viscous and super-viscous substrates were prepared using “Thick-It” food thickener and a rotational viscometer. All swallows were administered in 5-mL increments in both supine and upright positions. HRiM metrics and impedance (bolus transit) were calculated. We used a paired two-tailed t test to compare all metrics by position and substrate.ResultsThe 5-g, 7-g, and 10-g substrates measured 5000, 36 200, and 64 700 mPa sec, respectively. In 18 volunteers, we observed that the integrated relaxation pressure was lower when upright than when supine for all substrates (P < 0.01). The 10-g substrate significantly increased integrated relaxation pressure when compared to saline in the supine position (P < 0.01). Substrates and positions also affected distal contractile integral, distal latency, and impedance values.ConclusionsWe examined HRiM values using novel standardized viscous and super-viscous substrates in healthy subjects for both supine and upright positions. We found that viscosity and position affected HRiM Chicago metrics and have potential to increase the sensitivity of esophageal manometry.

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Impedance characteristics of normal oesophageal motor function

Cited by 28 publications

References 34 publications

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

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

Evaluation of esophageal motor function in clinical practice

Improving High-resolution Impedance Manometry Using Novel Viscous and Super-viscous Substrates in the Supine and Upright Positions: A Pilot Study

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