The upper esophageal sphincter in the high-resolution manometry era

Norton, Pedro; Herbella, Fernando A. M.; Schlottmann, Francisco; Patti, Marco G.

doi:10.1007/s00423-021-02319-1

Cited by 6 publications

(3 citation statements)

References 64 publications

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“…Based on our initial findings, patients with EGJOO and isolated supine IRP had significantly higher UESNP than the normal HRM group. The findings support the hypothesis that the UES is hypertonic with impaired relaxation, which may serve as a protective mechanism to facilitate esophageal clearance and prevent aspiration pneumonitis under IRP elevation[ 15 ]. Further ROC analysis revealed that UESNP elevation might serve as a feature for confirming EGJOO.…”

Section: Discussionsupporting

confidence: 82%

Changes in the esophagogastric junction outflow obstruction manometric feature based on the Chicago Classification updates

Li¹,

Lu²,

Liu³

et al. 2022

WJG

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BACKGROUND The critical diagnostic criteria for esophagogastric junction outflow obstruction (EGJOO) were published in the latest Chicago Classification version 4.0 (CCv4.0). In addition to the previous criterion [elevated integrated relaxation pressure (IRP) in supine position], manometric diagnosis of EGJOO requires meeting the criteria of elevated median-IRP during upright wet swallows and elevated intrabolus pressure. However, with the diagnostic criteria modification, the change in manometric features of EGJOO remained unclear. AIM To evaluate the esophageal motility characteristics of patients with EGJOO and select valuable parameters for confirming the diagnosis of EGJOO. METHODS We performed a retrospective analysis of 370 patients who underwent high-resolution manometry with 5 mL water swallows × 10 in supine, × 5 in upright position and the rapid drink challenge (RDC) with 200 mL water from November 2016 to November 2021 at Peking University First Hospital. Fifty-one patients with elevated integrated supine IRP and evidence of peristalsis were enrolled, with 24 patients meeting the updated manometric EGJOO diagnosis (CCv4.0) as the EGJOO group and 27 patients not meeting the updated EGJOO criteria as the isolated supine IRP elevated group (either normal median IRP in upright position or less than 20% of supine swallows with elevated IBP). Forty-six patients with normal manometric features were collected as the normal high-resolution manometry (HRM) group. Upper esophageal sphincter (UES), esophageal body, and lower esophageal sphincter (LES) parameters were compared between groups. RESULTS Compared with the normal HRM group, patients with EGJOO (CCv4.0) had significantly lower proximal esophageal contractile integral (PECI) and proximal esophageal length (PEL), with elevated IRP on RDC ( P < 0.05 for each comparison), while isolated supine IRP elevated patients had no such feature. Patients with EGJOO also had more significant abnormalities in the esophagogastric junction than isolated supine IRP elevated patients, including higher LES resting pressure (LESP), intrabolus pressure, median supine IRP, median upright IRP, and IRP on RDC ( P < 0.05 for each comparison). Patients with dysphagia had significantly lower PECI and PEL than patients without dysphagia among the fifty-one with elevated supine IRP. Further multivariate analysis revealed that PEL, LESP, and IRP on RDC are factors associated with EGJOO. The receiver-operating characteristic analysis showed UES nadir pressure, PEL, PECI, LESP, and IRP on RDC are parameters supportive for confirming the diagnosis of EGJOO. CONCLUSION Based on CCv4.0, patients with EGJOO have more severe esophagogastric junction dysfunction and are implicated in the proximal esophagus. Additionally, several parameters are supportive for confirming the diagnosis of EGJOO.

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Section: Discussionsupporting

confidence: 82%

Changes in the esophagogastric junction outflow obstruction manometric feature based on the Chicago Classification updates

Li¹,

Lu²,

Liu³

et al. 2022

WJG

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“…UES can be hypotonic in the early stages of neurogenic diseases, such as stroke and Parkinson's disease, and progresses further to impaired relaxation. In Zenker's diverticulum, the UES has impaired relaxation 22 .…”

Section: Upper Esophageal Biometrics In Hremmentioning

confidence: 99%

High-resolution esophageal manometry in children

WAIKAR¹

2023

Clin Exp Pediatr

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Functional disorders of the esophagus are known as esophageal dysmotility disorders. Esophageal manometry can be used to study swallowing disorders, feeding problems, non-obstructive dysphagia, and lower esophageal dysfunction. This paper discusses the recent advances in and reviews the use of highresolution esophageal manometry in children. The Chicago 4.0 classification should be used judiciously in children. Manometric studies can guide the proper management of dysmotility in children.

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“…Manometric studies of the UES, including with high-resolution manometry (HRM), have provided important insights into UES function during deglutition. 5,11 However, manometric UES pressures are highly variable even in asymptomatic individuals, which is likely due to reactivity and the hyperdynamic behavior of the UES. 12 At the present moment, a key gap in our knowledge of esophageal pathophysiology is with respect to the mechanism of generation of supra-esophageal symptoms.…”

Section: Introductionmentioning

confidence: 99%

The Upper Esophageal Sphincter Distensibility Index Measured Using Functional Lumen Imaging Probe Identifies Defective Barrier Function of the Upper Esophageal Sphincter

Calderon

Kline

Hersh

et al. 2022

J Neurogastroenterol Motil

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Background/AimsThe mechanism via which supra-esophageal symptoms are generated is unclear. We assessed upper esophageal sphincter (UES) function in novel fashion using functional lumen imaging probe (FLIP) topography. We hypothesize that symptoms related to aspiration of esophageal contents may be associated with a more distensible UES. MethodsFLIP and reflux symptom index score data from patients undergoing diagnostic evaluation for an esophageal complaint over a 10-month period were analyzed retrospectively. UES distensibility on FLIP was studied at 40-70 mL volumes with in-depth analysis at 50 and 60 mL. Symptoms were compared between patients with low, middle, and high UES-distensibility index (UES-DI). Receiveroperating characteristic analysis was performed to determine associations between the UES-DI and individual reflux symptom index symptom item scores. ResultsOne hundred and eleven subjects were included. Overall, the associations between UES-DI and symptoms that could be related to supra-esophageal aspiration were strongest at the 50 mL FLIP volume. Choking item score was highest in the high UES-DI group (2.8) vs 1.4 (P < 0.001) in the middle UES-DI and 1.1 (P = 0.004) in the low UES-DI groups. Similarly, the cough item score was highest in the high UES-DI group (2.7) vs 1.5 (P = 0.009) and 0.9 (P = 0.002) groups. ConclusionA higher UES-DI measures defective barrier function which could may be the main pathophysiology that generates supra-esophageal symptoms.

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The upper esophageal sphincter in the high-resolution manometry era

Cited by 6 publications

References 64 publications

Changes in the esophagogastric junction outflow obstruction manometric feature based on the Chicago Classification updates

Changes in the esophagogastric junction outflow obstruction manometric feature based on the Chicago Classification updates

High-resolution esophageal manometry in children

The Upper Esophageal Sphincter Distensibility Index Measured Using Functional Lumen Imaging Probe Identifies Defective Barrier Function of the Upper Esophageal Sphincter

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