title: Ambulatory high-resolution manometry, lower esophageal sphincter lift and transient lower esophageal sphincter relaxation.
abstract: BACKGROUND
  Lower esophageal sphincter (LES) lift seen on high-resolution manometry (HRM) is a possible surrogate marker of the longitudinal muscle contraction of the esophagus. Recent studies suggest that longitudinal muscle contraction of the esophagus induces LES relaxation.
  
  
  OBJECTIVE
  Our goal was to determine: (i) the feasibility of prolonged ambulatory HRM and (ii) to detect LES lift with LES relaxation using ambulatory HRM color isobaric contour plots.
  
  
  METHODS
  In vitro validation studies were performed to determine the accuracy of HRM technique in detecting axial movement of the LES. Eight healthy normal volunteers were studied using a custom designed HRM catheter and a 16 channel data recorder, in the ambulatory setting of subject's home environment. Color HRM plots were analyzed to determine the LES lift during swallow-induced LES relaxation as well as during complete and incomplete transient LES relaxations (TLESR).
  
  
  RESULTS
  Satisfactory recordings were obtained for 16 h in all subjects. LES lift was small (2 mm) in association with swallow-induced LES relaxation. LES lift could not be measured during complete TLESR as the LES is not identified on the HRM color isobaric contour plot once it is fully relaxed. On the other hand, LES lift, mean 8.4 ± 0.6 mm, range: 4-18 mm was seen with incomplete TLESRs (n = 80).
  
  
  CONCLUSIONS
  Our study demonstrates the feasibility of prolonged ambulatory HRM recordings. Similar to a complete TLESR, longitudinal muscle contraction of the distal esophagus occurs during incomplete TLESRs, which can be detected by the HRM. Using prolonged ambulatory HRM, future studies may investigate the temporal correlation between abnormal longitudinal muscle contraction and esophageal symptoms.
authors.affiliation: Division of Gastroenterology, San Diego VA Health Care System and University of California, San Diego, CA, USA. rmittal@ucsd.edu
authors.forename: R K
authors.initials: RK
authors.lastname: Mittal
authors.forename: A
authors.initials: A
authors.lastname: Karstens
authors.forename: E
authors.initials: E
authors.lastname: Leslie
authors.forename: A
authors.initials: A
authors.lastname: Babaei
authors.forename: V
authors.initials: V
authors.lastname: Bhargava
mesh_terms: D000328:Adult; D049630:Esophageal Sphincter, Lower / Q000502:physiology*; D006801:Humans; D008365:Manometry / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000295:instrumentation / Q000379:methods*; D009119:Muscle Contraction / Q000502:physiology*; D009126:Muscle Relaxation / Q000502:physiology*; D055815:Young Adult
references.citation: Neurogastroenterol Motil. 2006 Dec;18(12):1056-61
references.pmid: 17109688
references.citation: Gastroenterology. 2008 May;134(5):1322-31
references.pmid: 18384786
references.citation: Gastroenterology. 2006 Feb;130(2):334-40
references.pmid: 16472589
references.citation: Gut. 2008 Feb;57(2):161-6
references.pmid: 17895353
references.citation: Gut. 1993 Mar;34(3):303-8
references.pmid: 8472975
references.citation: Am J Physiol. 1991 Mar;260(3 Pt 1):G512-6
references.pmid: 2003613
references.citation: Am J Physiol Gastrointest Liver Physiol. 2001 Sep;281(3):G743-51
references.pmid: 11518687
references.citation: Gut. 2010 Apr;59(4):433-40
references.pmid: 20332517
references.citation: J Clin Invest. 1973 Jan;52(1):1-13
references.pmid: 4682383
references.citation: Gastroenterology. 1999 Jan;116(1):29-37
references.pmid: 9869599
references.citation: Gut. 2006 Apr;55(4):584-5
references.pmid: 16354796
references.citation: Gastroenterology. 2008 Nov;135(5):1526-33
references.pmid: 18722376
references.citation: Gastroenterology. 2011 Feb;140(2):442-9
references.pmid: 20955702
references.citation: Gastroenterology. 1986 Jul;91(1):133-40
references.pmid: 3710062
references.citation: Am J Physiol Gastrointest Liver Physiol. 2006 Mar;290(3):G431-8
references.pmid: 16210472
references.citation: Gastroenterology. 2005 Feb;128(2):487-97
references.pmid: 15685559
references.citation: J Clin Invest. 1980 Feb;65(2):256-67
references.pmid: 7356677
references.citation: Gastroenterology. 2006 Dec;131(6):1725-33
references.pmid: 17087957
references.citation: Gastroenterology. 1995 Aug;109(2):601-10
references.pmid: 7615211
references.citation: Am J Physiol Gastrointest Liver Physiol. 2007 Jan;292(1):G329-34
references.pmid: 17023549
references.citation: Am J Physiol. 1998 Oct;275(4):G805-11
references.pmid: 9756512
references.citation: Gastroenterology. 1997 Apr;112(4):1147-54
references.pmid: 9097997
references.citation: Am J Physiol Gastrointest Liver Physiol. 2006 Jun;290(6):G1149-56
references.pmid: 16439471
references.citation: Gastroenterology. 1976 Aug;71(2):263-7
references.pmid: 939387
references.citation: Am J Physiol Gastrointest Liver Physiol. 2001 Oct;281(4):G1022-33
references.pmid: 11557523
references.citation: Am J Physiol Gastrointest Liver Physiol. 2009 Aug;297(2):G397-405
references.pmid: 19520741
references.citation: Gastroenterology. 2010 Jul;139(1):102-11
references.pmid: 20381493
references.citation: AJR Am J Roentgenol. 1977 Apr;128(4):549-61
references.pmid: 403780
references.citation: Dig Dis. 2006;24(3-4):319-41
references.pmid: 16849860