Flow time through esophagogastric junction derived during high-resolution impedance-manometry studies: a novel parameter for assessing esophageal bolus transit.
This study aimed to develop and validate a method to measure bolus flow time (BFT) through the esophagogastric junction (EGJ) using a high-resolution impedance-manometry (HRIM) sleeve. Ten healthy subjects were studied with concurrent HRIM and videofluoroscopy; another 15 controls were studied with HRIM alone. HRIM studies were performed using a 4.2-mm-outer diameter assembly with 36 pressure sensors at 1-cm intervals and 18 impedance segments at 2-cm intervals (Given Imaging, Los Angeles, CA). HRIM and fluoroscopic data from four barium swallows, two in the supine and two in the upright position, were analyzed to create a customized MATLAB program to calculate BFT using a HRIM sleeve comprising three sensors positioned at the crural diaphragm. Bolus transit through the EGJ measured during blinded review of fluoroscopy was almost identical to BFT calculated with the HRIM sleeve, with the nadir impedance deflection point used as the signature of bolus presence. Good correlation existed between videofluoroscopy for measurement of upper sphincter relaxation to beginning of flow [R = 0.97, P < 0.001 (supine) and R = 0.77, P < 0.01 (upright)] and time to end of flow [R = 0.95, P < 0.001 (supine) and R = 0.82, P < 0.01 (upright)]. The medians and interquartile ranges (IQR) of flow time though the EGJ in 15 healthy subjects calculated using the virtual sleeve were 3.5 s (IQR 2.3-3.9 s) in the supine position and 3.2 s (IQR 2.3-3.6 s) in the upright position. BFT is a new metric that provides important information about bolus transit through the EGJ. An assessment of BFT will determine when the EGJ is open and will also provide a useful method to accurately assess trans-EGJ pressure gradients during flow.
Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
Zhiyue
Z
Lin
Gastroenterology and Hepatology Unit, Department of Internal Medicine, Assiut University Hospital, Assiut, Egypt.
Hala
H
Imam
Department of Thoracic Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; and.
Frèdèric
F
Nicodème
Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
Dustin A
DA
Carlson
Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
Chen-Yuan
CY
Lin
Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
Brandon
B
Yim
Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
Peter J
PJ
Kahrilas
Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; j-pandolfino@northwestern.edu.
John E
JE
Pandolfino
D000328:Adult; D000465:Algorithms; D001466:Barium Sulfate; D003287:Contrast Media; D003679:Deglutition; D017097:Electric Impedance; D004867:Equipment Design; D049631:Esophageal Sphincter, Upper / Q000502:physiology; D004943:Esophagogastric Junction / Q000000981:diagnostic imaging / Q000502:physiology*; D005260:Female; D005471:Fluoroscopy; D005772:Gastrointestinal Transit; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D008365:Manometry / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D056888:Patient Positioning; D011237:Predictive Value of Tests; D011312:Pressure; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D012212:Rheology; D016683:Supine Position; D013997:Time Factors; D014160:Transducers, Pressure; D014741:Video Recording; D055815:Young Adult
D003287:Contrast Media; D001466:Barium Sulfate
bolus transit; impedance; manometry