Vascular pressure bands on high-resolution esophageal manometry with impedance studies

Abstract

Horizontal pressure bands on high-resolution esophageal manometry with impedance (HREMI) tracings are often seen and thought to be due to cardiovascular structures compressing the esophagus. The aim of this study was to determine the prevalence and location of vascular pressure bands on HREMI studies and correlate these pressure bands to bolus clearance. HREMI studies in supine and upright positions from patients and normal volunteers were reviewed. Pressure bands were defined as bands of horizontal pressure greater than the 20 mmHg isobaric contour. Each swallow was reviewed with impedance to determine if bolus transit was impaired by the band. 38.6% of 251 patients and 36.4% of 11 normal controls had a pressure band present. There were a greater number of bands in supine versus upright position (patients: 130 vs. 25, P < 0.001 and controls: 6 vs. 1). Patients with pressure bands had similar demographics (age, gender, BMI) compared to those without. Average distal contractile integral of bands was greater in supine compared to upright (133 ± 201 vs. 60 ± 148 mmHg cm s, P < 0.05). Bands were commonly located clustered at 46 and 72% of esophageal length. Bolus transit was impaired by bands in 20.4% of supine and 14.0% of upright swallows. Vascular pressure bands can have a prominent appearance on HREMI studies, present in, being more prevalent and having greater pressure in the supine than the upright position. These vascular bands, when present, may impair esophageal transit.

Dysphagia lusoria: utility of high‐resolution impedance manometry to identify true disease

“…Although there was also delayed bolus transit, it is not clear whether this impedance abnormality was caused by DL. Horizontal pressure bands from cardiopulmonary structures are frequently found in both patients with dysphagia and healthy volunteers 9,13 . These vascular bands have been shown to sometimes impair esophageal bolus transit 13 .…”

“…Horizontal pressure bands from cardiopulmonary structures are frequently found in both patients with dysphagia and healthy volunteers 9,13 . These vascular bands have been shown to sometimes impair esophageal bolus transit 13 . In addition, he has pronounced globus sensation, which may be due to his elevated resting UES pressure 14 and his DL.…”

Rare Etiology of Vascular Bands on Esophageal Manometry

“…Vascular bands, also termed pulsatile pressure zones, vascular pressure bands, or horizontal pressure bands, identified during HRM occur frequently secondary to esophageal compression with abnormal vasculature, or cardiomegaly [1]. Previous studies identified that up to 56% of the HRM studies detected vascular bands [1][2][3]; moreover, the aortic arch, the aberrant subclavian artery and left atrium were categorized as the most implicated cardiovascular structures resulting in pressure bands [2]. While the clinical significance of vascular bands remains uncertain, they have been postulated to cause dysphagia in patients with additional underlying risk factors, such as, advanced age, atherosclerosis, and valvular heart disease [2].…”