Multichannel Intraluminal Impedance And Manometry Research Articles

153 THE CLINICAL SIGNIFICANCE OF INCOMPLETE BOLUS CLEARANCE IN PATIENTS WITH DYSPHAGIA

Abstract The primary function of the esophagus is to facilitate bolus transport to the stomach. High-resolution manometry assesses the functions of esophageal motility, but not the clearance of bolus transit through the esophagus. The development of combined multichannel intraluminal impedance and manometry (MII-EM) has enabled simultaneous measurement of bolus transport and manometry. This study investigated the effects of bolus transit on esophageal motility disorders and its effect on the quality of life of patients with dysphagia. Methods A total of 810 wet swallows were reviewed and analyzed in 81 patients with dysphagia who underwent MII-EM. Incomplete bolus clearance (IBC) was defined based on impedance measurement. IBC was classified into four types (A: normal, B: incomplete clearance in the upper esophagus, C: incomplete clearance in the lower esophagus, D: incomplete clearance of the whole esophagus), and was also evaluated according to the appearance rate of complete bolus transit. Then, the clinical significance of IBC was determined by our previously validated dysphagia symptom score and the SF8 quality of life instrument (physical component summary and mental component summary). Results There were 16 cases of esophageal achalasia (Ach), 9 of esophagogastric junction outflow obstruction (EGJOO), 8 of distal esophageal spasm (DES), 7 of Jackhammer esophagus (JE), 2 of absent contractility (AC), 10 of ineffective esophageal motility (IEM) and 29 normal cases. The figure shows the breakdown of IBC for each disorder. Complete bolus transit was found in 27.8% in EGJOO, 52.5% in DES, 14.2% in JE, 4.0% in IEM, and 83.3% in normal; no CBT was found in Ach and AC. Patients with IBC had significantly higher dysphagia symptom scores (p < 0.05) and lower mental component summaries (p < 0.05) than those without. Conclusion Patients with dysphagia with esophageal dysmotility were classified into two groups: those with and without IBC. Assessment of bolus transport is an important clinical marker for patients with dysphagia, because those with IBC had a significantly higher dysphagia symptom scores and impaired quality of life.

Assessment of esophageal motor function using combined multichannel intraluminal impedance and manometry in patients with achalasia

Summary Background Achalasia is characterized by esophageal aperistalsis and a failure of lower esophageal sphincter (LES) relaxation. Combined multichannel intraluminal impedance and manometry (MII-EM) allows the simultaneous recording of esophageal peristalsis and bolus transport patterns. The aim of this study was to evaluate the feasibility of MII-EM for the assessment of esophageal motility and to characterize patterns of esophageal bolus transport in patients with achalasia with or without Heller myotomy. Materials and methods A total of nine patients (2 men and 7 women, age range 25–46 years) were enrolled in this study. Two of the patients had previously undergone Heller myotomy. All patients underwent combined MII-EM with a nine-channel esophageal function testing catheter containing four impedance measuring segments and five solid-state pressure transducers. Each patient received 10 liquid and 10 viscous swallows in a sitting position. All tracings were recorded and analyzed for esophageal contractions and bolus transit. Results None of the patients with achalasia, whether they had undergone a Heller myotomy or not, had manometrically normal esophageal peristalsis during saline or viscous swallowing. They had a normal LES resting pressure, incomplete LES relaxation, and lower distal esophageal contraction. The LES relaxation percentages in the patients who had undergone Heller myotomy (97% and 51%) were higher than those of the untreated patients (mean 47%). All patients demonstrated a low baseline impedance level in the distal esophagus. Air trapping in the proximal esophagus was also detected in nearly all of the patients. None of the patients in either group had complete bolus transit with either saline or viscous swallows. Conclusion Patients with achalasia are characterized by poor esophageal contraction and absent esophageal bolus clearance and such abnormalities are still noticeable after Heller myotomy. Although combined MII-EM can provide additional information regarding esophageal bolus transit, a low baseline impedance level and air trapping in the proximal esophagus may limit its utility in the diagnosis of esophageal dysmotility in patients with achalasia.

Association Between Swallow Perception and Esophageal Bolus Clearance in Patients with Globus Sensation

Globus sensation is common, but its pathogenesis is not yet clear. Our purpose was to investigate subjective perception of swallowing and esophageal motility by combined multichannel intraluminal impedance and manometry (MII-EM) for patients with globus sensation. Combined MII-EM was performed for 25 globus patients and 15 healthy controls. Swallows were abnormal if hypocontractivity or simultaneous contractions occurred. Esophageal bolus transit was incomplete if bolus exit was not found at one or more of all measurement sites. Perception of each swallow was assessed by use of a standardized scoring system, and was enhanced if the score was >1. Few globus patients reported enhanced perception during viscous or solid swallows. Incomplete bolus transit and enhanced perception occurred similarly between viscous and solid boluses. Agreement between enhanced perception and proximal bolus clearance was greater during solid swallows (κ = 0.45, 95 % CI: 0.32-0.58) than during viscous swallows (κ = 0.13, 95 % CI: 0-0.25) (P < 0.05). Similarly, agreement between enhanced perception and total bolus clearance was greater during solid swallows (κ = 0.46, 95 % CI: 0.34-0.58) than during viscous swallows (κ = 0.11, 95 % CI: 0-0.22) (P < 0.05). Enhanced swallow perception is uncommon in patients with globus sensation, although there is a significant association between enhanced esophageal perception and solid bolus clearance. Application of a solid bolus may help better delineation of the interrelationship between the subjective perception of bolus passage and the objective measurement of bolus clearance.

W1125 Characteristics of Esophageal Motility in Patients With NERD Refractory for PPIs and a Treatment Strategy Using Rikkunshito – A Study Using Combined Multichannel Intraluminal Impedance and Manometry (MII-EM): Part II

Background: More than 50% of non-erosive gastroesophageal reflux disease (NERD) patients have a poor response to proton pump inhibitors (PPIs) treatment. Recently, it was reported that esophageal motility disorder involving a decline in esophageal clearance contributes to refractory for PPIs. However, there was few reports focused to esophageal motility of patients with NERD refractory for PPIs and there is no established strategy for treatment of refractory NERD. Aims: To clarify the characteristic of patients with refractory NERD, we investigated the esophageal function using MII-EM. In addition, we also evaluated the efficacy of rikkunshito which is a gastrointestinal prokinetic agent. Methods: In this study, 24 NERD patients including 15 patients with NERD refractory for PPIs treatment. Refractory NERD was defined as a score of more than 6 points in the QUEST questionnaire after PPI treatment for over than 4 weeks. After wash-out of gastrointestinal-related drugs, all enrolled patients underwent the examinations using MII-EM and then started oral administration of rikkunshito (7.5 g/ day). After rikkunshito treatment for 8 weeks, the examinations using MII-EM was performed again. Also, symptoms were assessed using the Gastrointestinal Symptom Rating Scale (GSRS) before and 4 weeks / 8 weeks after starting the rikkunshito treatment. Results: At first examination using MII-EM, 71.4% of the refractory NERD patients had peristaltic contraction rate (PC rate) deviating from the standard value (≧80%) and 85.7% of them had a complete bolus transit rate (CBT rate) deviating from the standard value (≧75%). On the other hand, in the 9 patients other than the refractory NERD, the rate of patients with such deviation was 25.0% and 50.0%, respectively. The rate of patients with a resting LES pressure deviating from the standard value was comparable between the two patient groups. Next, we also evaluated the efficacy of rikkunshito in the refractory NERD. Rikkunshito significantly improved the LES residual pressure during swallow from 7.2 ± 5.1 mmHg to 5.2 ± 4.1 mmHg, PC rate from 52.4 ± 34.6% to 75.5 ± 31.1% and CBT rate from 51.5 ± 27.4% to 81.8 ± 16.0%. In assesment of symptoms with GSRS, rikkunshito significantly improved score of acid reflux symptoms, dyspepsia-like symptoms and total gastrointestinal symptoms. Conclusion: These results suggested that the refractory NERD patients had a disorder of esophageal motility and that rikkunshito ameliorated the gastrointestinal symptoms through improvement of the esophageal and LES motility disorder. We propose the application of rikkunshito as a strategy to treat patients with NERD refractory for PPIs.

M1876 Rikkunshito Improves Esophageal Motility Disorder and Symptoms in Patients with NERD - a Study Using Combined Multichannel Intraluminal Impedance and Manometry (MII-EM) -

Background: Proton pump inhibitors (PPI) are the drug of first choice for treating patients with gastroesophageal reflux disease (GERD). However, about 50% of non-erosive reflux disease (NERD) patients have a poor response to PPI treatment. It is reported that esophageal motility disorder involving a decline in esophageal clearance contributes to the poor PPI response. Accordingly, a drug capable of enhancing esophageal motility would be beneficial in the treatment of NERD patients. Rikkunshito, a gastrointestinal prokinetic agent, is known to improve esophageal clearance in GERD patients and gastric emptying in functional dyspepsia patients and to increase secretion of ghrelin in rats. Aim: To clarify the efficacy of rikkunshito in NERD patients, we evaluated the effects of rikkunshito on esophageal and lower esophageal sphincter (LES) motility and symptoms. Methods: Fifteen patients were enrolled in the study. They were diagnosed as having NERD according to endoscopic testing and the score (6 points or more) obtained on the questionnaire for the diagnosis of reflux disease (QUEST). All patients stopped taking all gastrointestinal-related drugs for over 1 week prior to rikkunshito treatment, and were administered rikkunshito (7.5 g per day, orally) for 8 weeks. Esophageal and LES functions during liquid or semisolid swallow were evaluated using MII-EM following gold standard methods before and after rikkunshitotreatment. Symptoms were assessed using the Gastrointestinal Symptom Rating Scale (GSRS) before, 4 weeks after, and 8 weeks after treatment. Results: Rikkunshito-treatment significantly improved the mean of complete bolus transit (CBT) during liquid or semisolid swallow from 60.7±7.7% to 90.0±5.8% (p 79%, semisolid: >69%) for CBT decreased from 53.3% to 16.7% and from 60.0% to 33.3% after treatment, respectively. In manometry evaluation, rikkunshito significantly improved the mean of LES residual pressure during liquid swallow from 6.0±1.3 mmHg to 3.8±1.4 mmHg (p<0.05). In addition, rikkunshito significantly ameliorated total GI symptom scores in GSRS (from 2.1±0.2 to 1.6±0.1: (p<0.05)) and showed a tendency toward improvement of subscales for reflux symptoms, abdominal pain and dyspeptic symptoms. Conclusion: We found that rikkunshito improved the esophageal clearance and symptoms in NERD patients through the amelioration of esophageal and LES motility disorder. Thus, rikkunshito may become a useful drug for treating NERD patients.

Gatorade Is a Good Substitute for Normal Saline in Multichannel Intraluminal Impedance and Manometry

Purpose: Multichannel intraluminal impedance and manometry (MII-EM) is a method evaluating esophageal motility and bolus transit. Patients swallow 5 ml of normal saline during their swallow assessment. Due to the taste of normal saline, patients quite often complain. Normal saline was initially chosen as the liquid challenge medium for swallowing because of its high electrolyte contents which is needed for good electrical conductance for the MII part of the test. Gatorade is also rich in electrolytes, thought less than normal saline. The aim of this study was to evaluate the usage of Gatorade as a substitute for normal saline in MII-EM. Methods: 15 patients (3 males; 12 females) scheduled for esophageal function testing were studied with an MII-EM catheter: 4 impedance measuring segments (5, 10, 15 and 20 cm above LES (lower esophageal sphincter)) and 5 solid state pressure transducers (within the LES and 5, 10 15 and 20 cm above LES). Each subject was given 10 swallows of 5 ml of normal saline and 10 swallows of 5 ml of Gatorade. The studies were assessed and results were compared using PRISM statistical software. Results: In the normal saline study, 14 patients had normal manometry and 1 patient had nutcracker esophagus. In the Gatorade study, 12 patients had normal manometry, 2 patients had ineffective esophageal motility and 1 patient had nutcracker esophagus. The patient with nutcracker esophagus had the same diagnosis using both saline and Gatorade. Thus there is an 87% concordance between the two studies. All the normal saline as well as the Gatorade studies had complete bolus transit, as defined by at least 80% complete swallows on MII. Both studies had a statistically significant correlation in distal esophageal amplitude (P < 0.001, pearson r = 0.95) and total bolus transit time (P < 0.001, pearson r = 0.92). Conclusion: This initial study indicates that Gatorade may be a good substitute to normal saline in MII-EM as it provides similar results. Furthermore, it is more palatable for most patients. Further testing will be needed to confirm these results.

Revised Criterion for Diagnosis of Ineffective Esophageal Motility Is Associated With More Frequent Dysphagia and Greater Bolus Transit Abnormalities

Ineffective esophageal motility (IEM) has been defined by the presence of > or = 30% liquid swallows with contraction amplitude < 30 mmHg (ineffective swallows) in the distal esophagus ("old" IEM). A recent study with combined multichannel intraluminal impedance and manometry (MII-EM) raised the question whether the manometric diagnosis of IEM should be based on a new definition: > or = 50% ineffective liquid swallows ("new" IEM). The aim of this study was to evaluate the association between the number of ineffective liquid swallows and symptoms and bolus transit in patients with "new" or "old" IEM who underwent MII-EM studies using 10 liquid and 10 viscous swallows. There were 150 patients with "old" IEM included in the study. The patients diagnosed with "old" IEM (N = 150) (group A) were compared with those who retained a manometric diagnosis of IEM by the new definition (N = 101) (group B). The patients who did not retain their manometric diagnosis of IEM by the new definition (N = 49) (group C) were compared with group B. IEM was characterized as mild (normal bolus transit for both liquid and viscous swallows), moderate (abnormal bolus transit either for liquid or viscous swallows), or severe (abnormal bolus transit for both liquid and viscous swallows). There was no statistical difference in frequency of mild, moderate, or severe IEM and frequency of symptoms between group A and B. Group C had a significantly higher frequency of mild IEM and significantly lower frequency of severe IEM than group B. Heartburn (25.7%vs 10.2%, P= 0.03) and dysphagia (24.8%vs 12.3%, P= 0.08) showed a trend towards a greater frequency in group B than in group C. Our study indicates that IEM with > or = 50% ineffective liquid swallows is frequently associated with bolus transit abnormalities and esophageal symptoms. Our results underscore the rationale for using the new definition of IEM.

Normal values for manometry performed with swallows of viscous test material

Objective. Esophageal function testing with combined multichannel intraluminal impedance and manometry (MII-EM) is performed using ten 5-ml liquid and viscous swallows. Diagnosis of bolus transit abnormalities identified by impedance is based on both liquid and viscous swallows. Manometric diagnosis is based solely on liquid swallows. The aim of this study was to establish the normal values for manometry performed with a viscous bolus. Material andmethods. MII-EM studies performed in 80 healthy volunteers were analyzed. The analyzed manometric parameters included contraction amplitude and duration, distal onset velocity and lower esophageal sphincter (LES) residual pressure. Results. Mean distal esophageal amplitude (DEA) (mmHg) for liquid swallows was 104 (±44) and for viscous swallows 102 (±51). Viscous versus liquid swallows were characterized by higher contraction amplitudes at 10 cm above the LES, slower distal onset velocities and higher LES residual pressures. Duration of contractions was similar between liquid and viscous swallows. Upper normal limits for viscous swallows were: 204 mmHg for DEA (mean±2 SDs); 6 ineffective and 1 simultaneous swallows and 11.7 mmHg for LES residual pressure (95th percentile). Conclusions. Based on our results, the following values should be considered normal for manometry performed with viscous swallows: ≤60% ineffective contractions, ≤10% simultaneous contractions and DEA <204 mmHg, LES residual pressure ≤11.7 mmHg.

Multichannel intraluminal impedance and esophageal manometry data for unrestricted swallowing: establishing normal values

Standard esophageal manometric testing evaluates swallowing in the supine position using small boluses, with a recovery period imposed between swallows. Manometric tests of more physiologic unrestricted swallowing have had limited practical application due to highly variable results. The purpose of this study is to apply multichannel intraluminal impedance and manometry (MII-EM) to test esophageal function during unrestricted upright meal consumption, and to assess results in a normal healthy population. Ten healthy volunteers with normal esophageal impedance and manometry by published criteria underwent MII-EM testing using a combined 5-channel catheter. After transnasal placement of the catheter, each subject sat upright and consumed a meal that consisted of two pieces of toasted bread and two ounces of Gatorade. There were no restrictions placed on chewing, swallowing, or eating time. All data assessed by the MII-EM meal test were normally distributed. Impedance results with limited variability included the meal duration, number of swallows, postprandial emptying time and the percent of bolus presence times at 15, 10, and 5 cm above the lower esophageal sphincter. Manometric results with limited variability included the number of peristaltic sequences, mean time between these sequences and their distal esophageal amplitudes. MII-EM can be used to collect data with minimal variability in healthy subjects during unrestricted upright meal consumption. This technique may be used to identify abnormal motility patterns during physiologic swallowing.

Regional Esophageal Dysfunction in Scleroderma and Achalasia using Multichannel Intraluminal Impedance and Manometry

Achalasia and scleroderma are esophageal motility abnormalities characterized by severely impaired bolus transit. Combined multichannel intraluminal impedance and manometry (MII-EM) enables the simultaneous measurement of intraesophageal pressures and bolus transit at various levels within the esophagus. The aim of the study was to evaluate and characterize regional pressure and transit profile differences in scleroderma and achalasia patients. A retrospective analysis was carried out of MII-EM studies of patients with scleroderma (15), achalasia (20), and poorly relaxing lower esophageal sphincter (LES) with normal esophageal body function (20) as a control group. Bolus presence and segmental transit were evaluated by MII. In patients with achalasia, bolus transit was impaired across all four sites compared with scleroderma (P < 0.0125) even though distal esophageal pressures were higher (P < 0.05) in patients with achalasia. Pressures in patients with achalasia were similar across all four sites (ANOVA; saline, P = 0.373; viscous, P = 0.615). Bolus clearance rates and contraction amplitudes in patients with scleroderma decreased from proximal to distal. In the control group, bolus clearance was complete during > or = 83% of all swallows and esophageal pressure amplitudes increased distally. While the overall bolus transit is impaired in both patients with achalasia and scleroderma regional pressure and bolus transit differences exist. Bolus transit abnormalities result from abnormal esophageal body contraction and not abnormal LES relaxation.

Impedance manometry with viscous test solution increases detection of esophageal function defects compared to liquid swallows

Objective. Multichannel intraluminal impedance and manometry (MII-EM) is performed using ten 5-ml swallows each of a liquid and a viscous solution. However, the manometric diagnosis is based solely on results from the 10 liquid swallows. The aim of this study was to compare esophageal function evaluated with 10 liquid versus 10 viscous swallows using combined MII-EM in patients with various symptoms. Material and methods. Consecutive studies performed in 300 patients (211F, mean age 54.5 years) were analyzed. The manometric diagnoses were separated into normal and abnormal manometry. MII findings included the number of complete and incomplete transits and total bolus transit time. Results. Manometric diagnosis for liquid and viscous solutions was consistent in 231 (77%) and inconsistent in 69 (23%) patients (p<0.0001). Overall, the number of manometric abnormalities detected with the viscous solution (n=91, 30.3%) was significantly higher (p=0.03) than that detected with the liquid solution (n=60, 20%). Impedance diagnosis for the viscous and liquid solutions was consistent in 238 (79.3%) patients and inconsistent in 62 (20.7%) patients (p<0.0001). Among those 62 patients, 36 (58.1%) had complete bolus transit with the liquid solution and incomplete bolus transit with the viscous solution, and 26 (41.9%) had incomplete bolus transit with the liquid solution and complete transit with the viscous solution (p=0.46). Overall, there was no significant difference between the number of bolus transit abnormalities for the liquid (n=75, 25%) and viscous solutions (n=85, 28.3%, p=0.47). Conclusions. Our results indicate that a viscous solution detects significantly more manometric abnormalities than a liquid solution. Impedance diagnosis has greater similarity for both the liquid and viscous solutions.

Impedance-Manometry with Viscous Test Solution Increases Detection of Esophageal Function Defects

Purpose: Multichannel intraluminal impedance and manometry (MII-EM) is performed using ten 5 ml swallows each of both liquid and viscous solution. The manometric diagnosis is based solely on results from the 10 liquid swallows. It was recently demonstrated that manometric diagnoses based on 10 liquid and 10 viscous swallows combined were similar to those with 10 liquid swallows alone. The aim of the study was to compare esophageal function evaluated with 10 liquid versus 10 viscous swallows using combined MII-EM in patients with various symptoms. Methods: We analyzed consecutive MII-EM studies performed in 300 patients (211 women, mean age 54.5 yrs). The manometric diagnoses were separated into normal manometry and abnormal manometry. MII findings included number of complete and incomplete transits and total bolus transit time. Results: The results are summarized in Tables 1–2.Table: Manometric and impedance diagnoses for liquid and viscous swallows.Table: Mean characteristics of liquid and viscous swallows.Manometric diagnosis for liquid and viscous was consistent in 231 (77%) and inconsistent in 69 (23%) patients (p < 0.0001). Among these 69 patients, 48 had abnormal viscous and normal liquid manometry, 17 had normal viscous and abnormal liquid manometry and 4 had different abnormalities in liquid and viscous manometry (p < 0.0001). Impedance diagnosis for viscous and liquid was consistent in 238 (79.3%) patients and inconsistent in 62 (20.7%) patients (p < 0.0001). Conclusions: Our results indicate that viscous solution detects more manometric abnormalities than liquid solution. Impedance diagnosis has greater similarity for both liquid and viscous solutions.

Assessment of esophageal motor function using combined multichannel intraluminal impedance and manometry in healthy volunteers: A single‐center study in Taiwan

Combined multichannel intraluminal impedance and manometry (MII-EM) allow simultaneous measurement of both pressure and bolus transit. The aim of this study was to establish normative data in Chinese subjects for combined MII-EM and to correlate liquid and viscous bolus transit by impedance with esophageal contractions by manometry. Eighteen normal volunteers (six women and 12 men; mean age 24 years, range 19-36 years) underwent combined MII-EM with a catheter containing four impedance-measuring segments and five solid-state pressure transducers. Each subject received 10 liquid and 10 viscous material swallows of 5 mL each. Tracings were analyzed for bolus presence time, total bolus transit time, contraction amplitude, duration, and onset velocity. A total of 180 liquid and viscous swallow responses were analyzed. In all, 98.4% percent of manometrically normal liquid and 97.7% of manometrically normal viscous swallows had complete bolus transit by impedance. More than half (56.3%) of manometrically ineffective liquid and 50% of ineffective viscous swallows had complete bolus transit. Nearly 90% of normal individuals had at least 70% complete liquid bolus transit while more than 90% of normal individuals had at least 70% complete viscous bolus transit. This study establishes normative data for combined MII-EM in a healthy Chinese population. These data will help provide impedance application in esophageal function testing with a reference range that could be utilized by future studies or clinical practices involving Chinese subjects.

Esophageal Function Testing: Role of Combined Multichannel Intraluminal Impedance and Manometry

Combined multichannel intraluminal impedance and manometry (MII-EM) is a relatively new technique that allows simultaneous measurement of intraesophageal pressures and bolus transit. Combined MII-EM has the ability to identify what percentage of manometric normal/peristaltic, ineffective, and simultaneous swallows have complete or incomplete bolus transit. Predictors of normal bolus transit in patients with ineffective esophageal motility are the distal esophageal amplitude, the number of sites with low amplitudes, and the overall number of manometric ineffective contractions. Outcome studies are necessary to evaluate whether combined MII-EM is superior to traditional manometry in evaluating patients with nonobstructive dysphagia and in identifying patients at risk for developing dysphagia after antireflux surgery.

DOES ABNORMAL ESOPHAGEAL FUNCTION OCCUR IN PATIENTS WITH NUTCRACKER ESOPHAGUS?

Purpose: Esophageal manometry (EM) is the gold standard for diagnosis of motility abnormalities. Nutcracker esophagus (NE) is defined by mean distal esophageal amplitude (DEA) exceeding 180 mm Hg. Data on the functional (i.e. bolus transit) implications of this finding are limited. Aim: To assess bolus transit in patients with NE using combined multichannel intraluminal impedance and manometry (MII-EM). Methods: In a retrospective review of 558 combined MII-EM tracings recorded at our institution we identified 43 patients (7.7%) with NE and compared their bolus transit patterns to 192 patients (34.4%) with normal esophageal manometry. Patients received 10 liquid (saline) and 10 viscous (apple-sauce like) swallows (5 ml each), 30 second apart. Bolus transit time (time elapsed from bolus entry in the proximal esophagus to bolus exit in the distal esophagus) and overall normal/abnormal bolus transit were recorded. Normal liquid bolus transit was defined as >80% swallows with complete bolus transit and normal viscous bolus transit was defined as >70% swallows with complete bolus transit Results: All but one (42/43; 98%) of patients with NE had complete bolus transit for both liquid and viscous swallows compared to 181/192 (94%) of those with normal manometry. Of the total swallows, 421/430 (97.9%) liquid swallows had complete bolus transit in the NE patients compared to 1792/1917 (93.5%) liquid swallows for normal manometry. The mean bolus transit time in the 43 patients with NE (6.5 ± 0.3 sec) was significantly (p = 0.014) shorter than that for the 192 patients with normal esophageal motility (7.5 ± 0.1 sec). Similarly the mean peristaltic onset velocity in the 43 patients with NE (2.6 ± 0.16 sec) was significantly (p = .04) faster than that for the 192 patients with normal esophageal motility (2.3 ± 0.07 sec). Conclusions: The high contraction amplitudes in patients with nutcracker esophagus are associated with more rapid esophageal transit; confirming the superphysiologic nature of this manometric finding. Nutcracker esophagus is not associated with a functional abnormality.

Esophageal multichannel intraluminal impedance and manometry (MII-EM) in 2 patients with eosinophilic esophagitis: can it help the diagnosis?

Esophageal multichannel intraluminal impedance and manometry (MII-EM) in 2 patients with eosinophilic esophagitis: can it help the diagnosis?

Is the use of viscous test solution in the upright position appropriate for esophageal multichannel intraluminal impedance and manometry (MII-EM)?

Is the use of viscous test solution in the upright position appropriate for esophageal multichannel intraluminal impedance and manometry (MII-EM)?

Esophageal function testing with combined multichannel intraluminal impedance and manometry: multicenter study in healthy volunteers.

Combined multichannel intraluminal impedance and manometry (MII-EM) assesses esophageal function by simultaneous measurement of both pressure and bolus transit. Normative data for this method have not been published. The aim of this study was to establish normative data for combined MII-EM and to correlate liquid and viscous bolus transit by impedance with esophageal contractions by manometry. Forty-three normal volunteers recruited from 4 centers (15 women, 28 men; age range, 21-72 years) underwent combined MII-EM with a catheter containing 4 impedance-measuring segments and 4 solid-state pressure transducers. Each center recruited and analyzed subjects independently, according to pre-established criteria. Each subject received 20 x 5 mL swallows, 10 liquid and 10 viscous material. Tracings were analyzed manually for bolus presence time, bolus head advance time, segmental transit times, total bolus transit time, contraction amplitude, duration, and onset velocity. Ninety-seven and four-tenths percent of manometrically normal liquid and 96.1% of manometrically normal viscous swallows had complete bolus transit by impedance. Almost half (47.2%) of manometrically ineffective liquid and 34.7% of ineffective viscous swallows had complete bolus transit, whereas 91.7% of manometric simultaneous liquid swallows and 54.5% of simultaneous viscous swallows had complete bolus transit. More than 93% of normal individuals had at least 80% complete liquid or at least 70% complete viscous bolus transit. This study establishes normative data for combined MII-EM. Combined MII-EM may be a more sensitive tool in assessing esophageal function compared to standard manometry because impedance can distinguish different bolus transit patterns. Studies in patients with manometrically defined esophageal motility abnormalities should help clarify the functional importance of manometric ineffective and simultaneous swallows.

Esophageal function in normal volunteers and patients with ineffective esophageal motifity (IEM) assessed through combined multichannel intraluminal impedance and manometry (MIL/EM)

Esophageal function in normal volunteers and patients with ineffective esophageal motifity (IEM) assessed through combined multichannel intraluminal impedance and manometry (MIL/EM)

Esophageal function in normal volunteers and patients with ineffective esophageal motifity (IEM) assessed through combined multichannel intraluminal impedance and manometry (MIL/EM)

Esophageal function in normal volunteers and patients with ineffective esophageal motifity (IEM) assessed through combined multichannel intraluminal impedance and manometry (MIL/EM)