Upper esophageal sphincter motility in gastroesophageal reflux disease in the light of the high-resolution manometry

Nadaleto, Barbara Fernandes; Herbella, Fernando A. M.; Pinna, Bruno; Patti, Marco G.

doi:10.1093/dote/dox001

Cited by 17 publications

(9 citation statements)

References 21 publications

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“…Findings on UES motility were further supported by the efficacy of UES assist device in the patients with laryngeal symptoms . However, another retrospective study that included 22 esophageal symptom patients, 22 extraesophageal symptom patients, and 44 healthy controls have found that both esophageal symptom patients and extraesophageal symptom patients had lower UES basal pressure and shorter UES length than healthy controls . Whether UES motility impairment is unique to LPR still remains uncertain.…”

Section: Discussionmentioning

confidence: 96%

A study of proximal esophageal baseline impedance in identifying and predicting laryngopharyngeal reflux

Chen

Liang

Zhang

et al. 2020

J of Gastro and Hepatol

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Background and Aim: Laryngopharyngeal reflux (LPR) is caused by the reflux of gastric contents beyond the esophagus into the larynx and pharynx. However, upper esophageal sphincter (UES) motility and proximal esophagus reflux parameters are poorly studied. This study aims to explore the characteristics of UES motility and reflux parameter among LPR patients. Methods: Patients with laryngopharyngeal symptoms only (L), patients with laryngopharyngeal symptoms and typical esophageal symptoms (L + E), patients with typical esophageal symptoms only (E), and healthy controls (H) were retrospectively included. Physiological profiles were studied and compared among groups using both high-resolution manometry and pH-impedance monitoring, including UES basal pressure, residual pressure, relaxation duration time, recovery time, the time to nadir pressure, UES length, proximal contractile integral, and proximal mean nocturnal baseline impedance (MNBI). Patients' symptom outcomes were also analyzed. Results: A total of 242 patients were included. Proximal MNBI was significantly lower in patients with both laryngopharyngeal and esophageal symptoms (17 cm above low esophageal sphincter [LES]: L vs L + E vs E vs H = 3689.7 vs 2500.0 vs 3073.0 vs 3996.0; 15 cm above LES: L vs L + E vs E vs H = 3155.9 vs 2553.4 vs 3198.9 vs 2985.2; P < 0.001). Patients responded to proton pump inhibitor treatment also had lower proximal MNBI than those who did not (17 cm above LES: 1834.0 vs 3500.0; 15 cm above LES: 1946.5 vs 3432.6; P < 0.001). Conclusion: Decreased proximal MNBI can not only identify LPR patients but also predict patients' symptom outcomes.

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Section: Discussionmentioning

confidence: 96%

A study of proximal esophageal baseline impedance in identifying and predicting laryngopharyngeal reflux

Chen

Liang

Zhang

et al. 2020

J of Gastro and Hepatol

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“…Results from our study are consistent with the physiological profile of the UES linked to supra-esophageal symptoms in prior studies. Nadaleto et al 15 found a shorter UES length and greater percentage of UES hypotonicity on HRM in patients with extraesophageal symptoms versus typical GERD symptoms. In another elegant study, Babaei et al 16 studied UES responses measured on HRM to rapid saline injection and slow acid infusion in healthy controls, typical GERD patients, and those with supra-esophageal symptoms.…”

Section: Discussionmentioning

confidence: 98%

“…13,14 HRM studies have demonstrated that a hypotonic UES and impaired UES reflexes are associated with supra-esophageal symptoms. 15,16 Thus, a reasonable hypothesis is that defective UES barrier function could be a cause of supraesophageal 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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“…A study evaluating UES motility in patients with GERD reported that almost half of the patients had a short and hypotonic UES, and in those with extraesophageal symptoms, the proportion of hypotonic UES was even higher. 16 In another study, abnormalities in UES function were found in one-third of the patients with gastroesophageal reflux, including patients with laryngopharyngeal reflux and patients with typical GERD. The most common alteration was abnormal UES basal pressure (median of 59.8 mm Hg) in patients with GERD (normal reference value 73.5 mm Hg).…”

Section: Review Of a Particular Subjectmentioning

confidence: 94%

“…Torrico et al 13 Increase pressure during reflux Kuribayashi et al 15 Increase pressure during reflux Bognár et al 19 Hypertensive sphincter Kim et al 29 Increase UES pressure during transient LES relaxation Babaei et al 32 No increase in pressure during slow infusion of liquid into esophageal body Nadaleto et al 16 Short and hypotonic sphincter Benjamin et al 17 Decreased pressure Passaretti et al 18 Decreased pressure in patients with pharyngeal reflux Mendell et al 21 Slower transit through the sphincter Cassiani et al 22 Slower transit through the sphincter Alkan et al 30 No alteration of cricopharyngeal EMG Bastian et al 39 Inability to belch Abbreviations: EMG, electromyography; LES, lower esophageal sphincter; UES, upper esophageal sphincter.…”

Section: Reference Ues Alterationmentioning

confidence: 99%

Functional Changes of the Upper Esophageal Sphincter in Gastroesophageal Reflux

Dantas

2021

Int Arch Otorhinolaryngol

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Introduction The upper esophageal sphincter (UES) is a muscular structure located at the transition from the pharynx to the esophagus, with the cricopharyngeal muscle as the most important component. During gastroesophageal reflux, the pressure in the UES elevates, which is apparently a protective mechanism to prevent esophagopharyngeal reflux and airway aspiration. In gastroesophageal reflux disease (GERD), there may be functional changes in the UES. Objective The objective of the present review was to determine UES functional changes in GERD. Data Synthesis In healthy individuals, gastroesophageal reflux causes an increase in the UES pressure. This response of the sphincter is at least partially impaired in patients with GERD. In the disease, the UES has a reduced length and decreased resting pressure. However, other publications found that in chronic gastroesophageal reflux the basal sphincter pressure increase, differences which may be consequent to the measurement method or to disease severity. The UES opening during swallowing has a smaller diameter, and the bolus transit time through the sphincter is longer. Conclusion The UES of patients with GERD does not open as expected and the bolus flow through the sphincter is longer. This behavior may be associated with dysphagia, a frequent complaint in patients with GERD.

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Upper esophageal sphincter motility in gastroesophageal reflux disease in the light of the high-resolution manometry

Cited by 17 publications

References 21 publications

A study of proximal esophageal baseline impedance in identifying and predicting laryngopharyngeal reflux

A study of proximal esophageal baseline impedance in identifying and predicting laryngopharyngeal reflux

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

Functional Changes of the Upper Esophageal Sphincter in Gastroesophageal Reflux

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