title: Esophageal pressure topography criteria indicative of incomplete bolus clearance: a study using high-resolution impedance manometry.
abstract: OBJECTIVE
  This study used high-resolution impedance manometry (HRIM) to determine pressure topography thresholds of peristaltic integrity predictive of incomplete esophageal bolus clearance.
  
  
  METHODS
  A total of 16 normal controls and 8 patients with dysphagia were studied using a solid-state HRIM assembly incorporating 36 manometric sensors and 12 impedance segments. Each of the 10 saline swallows in each study was dichotomously scored as either complete or incomplete bolus clearance by impedance criteria, and peristaltic integrity was evaluated using pressure topography isobaric contours ranging from 10 to 30 mm Hg in 5- mm Hg increments. Each isobaric contour plot was characterized by the location and length of breaks in the isobaric contour.
  
  
  RESULTS
  All subjects had normal esophagogastric junction (EGJ) relaxation and none met the pressure topography criteria of hiatus hernia. In all, 70 (29%) of the 240 individual swallows had incomplete bolus clearance. In every case, an intact >or=20 mm Hg isobaric contour was associated with complete bolus clearance. The largest defect in the 20 and 30 mm Hg isobaric contours associated with complete bolus clearance measured 1.7 and 3.0 cm, respectively, in length, whereas the smallest defect predictive of incomplete bolus clearance measured 2.1 and 3.2 cm, respectively.
  
  
  CONCLUSIONS
  In individuals with normal EGJ relaxation and morphology, peristaltic contractions with breaks <2 cm in the 20 mm Hg isobaric contour or <3 cm in the 30 mm Hg isobaric contour are associated with complete bolus clearance, and longer breaks predict incomplete bolus clearance.
authors.affiliation: Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611-2951, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Bulsiewicz
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kahrilas
authors.forename: Monika A
authors.initials: MA
authors.lastname: Kwiatek
authors.forename: Sudip K
authors.initials: SK
authors.lastname: Ghosh
authors.forename: Albert
authors.initials: A
authors.lastname: Meek
authors.forename: John E
authors.initials: JE
authors.lastname: Pandolfino
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology*; D017097:Electric Impedance; D015154:Esophageal Motility Disorders / Q000150:complications* / Q000175:diagnosis*; D004943:Esophagogastric Junction / Q000503:physiopathology*; D005260:Female; D005772:Gastrointestinal Transit / Q000502:physiology; D006801:Humans; D008297:Male; D008365:Manometry / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D012016:Reference Values; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D012815:Signal Processing, Computer-Assisted; D014160:Transducers, Pressure; D055815:Young Adult
references.citation: Am J Physiol. 1993 Mar;264(3 Pt 1):G407-13
references.pmid: 8460696
references.citation: Gastroenterology. 1991 Mar;100(3):596-605
references.pmid: 1993483
references.citation: Gastroenterology. 1988 Jan;94(1):73-80
references.pmid: 3335301
references.citation: Am J Gastroenterol. 2008 Aug;103(8):1898-905
references.pmid: 18637086
references.citation: Am J Physiol Gastrointest Liver Physiol. 2007 Nov;293(5):G1023-8
references.pmid: 17855763
references.citation: Dig Dis Sci. 1997 Sep;42(9):1859-65
references.pmid: 9331148
references.citation: Best Pract Res Clin Gastroenterol. 2008;22(4):601-16
references.pmid: 18656819
references.citation: Gut. 2004 Jul;53(7):1024-31
references.pmid: 15194656
references.citation: Am J Gastroenterol. 2005 Dec;100(12):2624-32
references.pmid: 16393211
references.citation: Gastroenterology. 2008 Nov;135(5):1526-33
references.pmid: 18722376
references.citation: Am J Gastroenterol. 2008 Jan;103(1):27-37
references.pmid: 17900331
references.citation: Gut. 2001 Jul;49(1):145-51
references.pmid: 11413123
references.citation: Neurogastroenterol Motil. 2004 Oct;16(5):533-42
references.pmid: 15500509
references.citation: Clin Gastroenterol Hepatol. 2004 Mar;2(3):230-6
references.pmid: 15017607
references.citation: J Clin Gastroenterol. 2008 May-Jun;42(5):627-35
references.pmid: 18364587
references.citation: Neurogastroenterol Motil. 2008 Dec;20(12):1283-90
references.pmid: 18662328
references.citation: Gut. 2003 Jun;52(6):784-90
references.pmid: 12740331