Oesophageal pressure‐flow metrics in relation to bolus volume, bolus consistency, and bolus perception

Omari, Taher; Wauters, Lucas; Rommel, Nathalie; Kritas, Stamatiki; Myers, Jenifer C

doi:10.1177/2050640613492157

Cited by 34 publications

(73 citation statements)

References 23 publications

(64 reference statements)

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“…the highest rate of incomplete LES relaxation was found with bread. Several healthy studies have shown an incremental esophageal response to increased bolus viscosity [19,20]. In the current study, a stronger distal contractile amplitude and longer LES relaxation period were recorded in the younger cohort with solid compared to liquid boluses.…”

Section: Discussionsupporting

confidence: 60%

Changes in Esophageal and Lower Esophageal Sphincter Motility with Healthy Aging

Besanko

Burgstad

Cock

et al. 2014

JGLD

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Background & Aims: Swallowing difficulties become increasingly prevalent in older age. Differences exist in lower esophageal sphincter (LES) function between older and younger patients with dysphagia, but the contribution of aging per se to these is unclear.Methods: Esophageal motor function was measured using high resolution manometry in older (aged 81±1.7 yrs) and younger (23±1.7 yrs) asymptomatic healthy adults. After baseline recording, motility was assessed by swallowing boluses of liquid (right lateral and upright postures) and solids. Basal LES pressure, integrated relaxation pressure, distal esophageal peristaltic amplitude and velocity were measured. Data are presented as mean ą SEM.Results: Despite a trend for lower basal LES pressure (15.7±2.9 mmHg vs. 21.0±0.2mmHg; P=0.08),completeness of LES relaxation was reduced in older subjects (liquid RL: P=0.003; UR: P=0.007; solid: P=0.03), with higher integrated relaxation pressure when upright (liquid: 6.9±1.1 vs. 3.1±0.4 mmHg; P=0.01; solids: 8.1±1.1 vs. 3.6±0.3 mmHg; P=0.001) and a longer time to recovery after liquid boluses (right lateral: P=0.01; upright: P=0.04). In young, but not older adults, esophageal peristaltic velocity was increased when upright (3.6±0.2 cm/sec; P=0.04) and reduced with solids (3.0±0.1 cm/sec; P=0.03). Distal contraction amplitude was higher with solids in the young (51.8±7.9 mmHg) but not older (41.4±6.2 mmHg; P=0.03) individuals. In elderly subjects, the distal contractile integral was higher with liquid swallows in the upright posture (P=0.006).Conclusion: There are subtle changes in LES function even in asymptomatic older individuals. These agerelated changes may contribute to the development of dysphagia.

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Section: Discussionsupporting

confidence: 60%

Changes in Esophageal and Lower Esophageal Sphincter Motility with Healthy Aging

Besanko

Burgstad

Cock

et al. 2014

JGLD

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“…This approach, called Pressure Flow Analysis (FPA), has now been applied to both pharyngeal and oesophageal swallow recordings from controls and patients. 41,[50][51][52][53][54][55][56][57][58][59][60] In practise, PFA is performed in an entirely automated, software-driven fashion whereby functional metrics are algorithmically derived following user selection of space-time landmarks which define regions of interest (ROI) on a standard Clouse EPT plot. Automated impedance manometry (AIM) software (called 'AIMplot') has been developed to enable PFA.…”

Section: Potential New Paradigms Integrating Pressure and Impedance Mmentioning

confidence: 99%

“…Table 1 summarises four studies that have assessed changes in PFA metrics in relation to the perception of bolus transit. 41,57,59,60 Of greatest interest in these early data is evidence that some metrics correlate with a heightened perception of bolus holdup and/or are altered in relation to vulnerability to dysphagia postfundoplication surgery. All metrics did not correlate with symptoms in all studies.…”

Section: Potential New Paradigms Integrating Pressure and Impedance Mmentioning

confidence: 99%

Impedance as an adjunct to manometric testing to investigate symptoms of dysphagia: What it has failed to do and what it may tell us in the future

2014

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Dysphagia is a common reason for referral for investigations of oesophageal motility. Impedance measurement has now been incorporated into commercially available diagnostic manometry systems for more than a decade. This innovation, which offered the ability to record patterns of bolus transport without the need for simultaneous radiology, has for the most part failed to live up to expectations, offering few additional diagnostic insights. This review examines the potential pitfalls related to how impedance patterns are currently analysed and introduces and discusses the new concept of pressure-flow analysis integrating pressure and impedance measurements to derive new metrics linked to the pressures occurring within and around the bolus as it is being transported.

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“…By quantifying the cumulative effects of three key pressure-flow metrics, the PFI attempts to embody the multifactorial causes of dysphagia in a single predictor of bolus flow resistance. In adult studies, the PFI has been shown to correlate with perception of bolus transit in both patients with non-obstructive dysphagia and healthy controls (Chen et al, 2013;Omari et al, 2013;Rommel et al, 2014). As the IR is a measure of the degree and extent of bolus clearance failure, elevated IR in dysphagic patients suggests that bolus residue build up may be one of the contributing factors of the perception of dysphagia.…”

Section: Discussionmentioning

confidence: 99%

Pressure-Flow Characteristics of Normal and Disordered Esophageal Motor Patterns

Singendonk

Kritas

Cock

et al. 2015

The Journal of Pediatrics

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Background:The Chicago Classification allows disordered esophageal motor dysfunction to be characterized into four main categories based on esophageal pressure topography (EPT) metrics. As an adjunct to EPT, pressure flow analysis relates impedance-detected bolus movement to pressure-detected bolus propulsion. The aim of this study was to perform pressure-flow analysis in a cohort of Chicago Classified pediatric patients. We hypothesized that patients within the different Chicago Classification categories would exhibit a different pressure-flow signature. Methods:Combined high-resolution impedance-and solid state pressure recordings were performed in 76 pediatric patients referred for diagnostic manometric investigation (32M; 9.1 ± 0.7 years) and 25 healthy adult controls (7M; 36.1 ± 2.2 years) using the Solar GI acquisition system (MMS, The Netherlands). Standardized saline and viscous boluses were tested. EPT metrics were calculated and an age-adjusted Chicago-Classification determined for each patient using MMS analysis software (version 8.23). Pressure-flow analysis of swallows was performed using purpose designed MATLAB-based software (AIMplot, T. Omari) which calculated the pressure-flow index (PFI), a composite measure of bolus pressurization relative to flow and the impedance ratio (IR) a measure of the extent of bolus clearance failure.Results: Based on EPT metrics, patients were mostly classified as Normal (38, 50%) or with a Category 4 disorder, usually weak peristalsis (28, 31.5%). Three (3.9%) had a Category 3 disorder, five (6.6%) had a Category 2 disorder (EGJ outflow obstruction) and two (2.6%) a

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Oesophageal pressure‐flow metrics in relation to bolus volume, bolus consistency, and bolus perception

Abstract: Bolus volume and bolus type alter oesophageal function and impact AIM analysis metrics descriptive of oesophageal function. Perception of bolus transit was associated with heightened bolus pressurization relative to bolus flow.

Cited by 34 publications

References 23 publications

Changes in Esophageal and Lower Esophageal Sphincter Motility with Healthy Aging

Changes in Esophageal and Lower Esophageal Sphincter Motility with Healthy Aging

Impedance as an adjunct to manometric testing to investigate symptoms of dysphagia: What it has failed to do and what it may tell us in the future

Pressure-Flow Characteristics of Normal and Disordered Esophageal Motor Patterns

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