Proximal Esophageal Contractions Research Articles

Unraveling the Dynamics of Esophageal Motility, Esophagitis Severity, and Age in GERD Patients: A Cross-Sectional Exploration.

Gastroesophageal reflux disease (GERD) is characterized by prolonged exposure of the esophageal mucosa to gastric content, with esophageal motility playing a pivotal role in its pathophysiology. This study employs a cross-sectional design to investigate the interplay between esophageal motility, the severity of esophagitis, and age in individuals presenting with GERD symptoms. The primary objective is to assess proximal and distal esophageal contractions in individuals with GERD symptoms, exploring potential correlations with the severity of esophageal lesions and age. A total of 47 patients reporting heartburn and acid regurgitation underwent diagnostic investigations, including esophageal manometry, radiological examinations, and endoscopy. Patients were categorized into groups based on the presence and severity of esophagitis. Esophageal contractions were monitored using a manometric method at various distances from the UES after swallowing 5 mL of water. Patients with severe esophagitis (SE) exhibited a reduced distal esophageal contraction amplitude compared to those without esophagitis (WE) or with moderate esophagitis (ME). No significant age-related differences were observed in esophageal contractions. Analyses included contraction amplitude, duration, area under the curve (AUC), and propagation time. This study provides insights into the nuanced relationship between esophageal motility, esophagitis severity, and age in GERD patients. The findings highlight the significance of distal esophageal contractions in SE cases, suggesting potential implications for disease progression. Age did not emerge as a significant factor influencing esophageal motility in this patient cohort.

Esophageal Dysmotility is Common in Patients With Multiple System Atrophy.

Esophageal dysmotility (ED) in patients with multiple system atrophy (MSA) are poorly understood. This study aimed to investigate the prevalence of ED in patients with MSA and to assess the relationship of esophageal abnormalities with other clinical findings and characteristics in these patients. A retrospective chart review was conducted to identify patients with MSA and to compare them to the elderly controls without MSA (65+ years) who underwent a videofluorographic esophagram from 2014 to 2019. Disease type, disease severity, vocal fold mobility impairment, abnormal deglutitive proximal esophageal contraction (ADPEC), and intra-esophageal stasis (IES) were reviewed and compared between groups. Thirty-seven patients with MSA were identified. The median age was 63 and 26 (70%) were male. These patients were matched to 22 elderly adults with presbylarynx but not MSA (median age 77, 68% male). In MSA patients, cerebellar variant type was predominant (59%), and ADPEC was recognized in 18 patients (49%). Disease severity level (P = 0.028) and existence of IES (P = 0.046) were associated with higher risks of developing ADPEC. The prevalence of IES was significantly higher in patients with MSA (95%) compared to controls without MSA (46%) (P < 0.001). Disease severity level and the existence of IES were significantly associated with the presence of ADPEC (p < 0.05). ADPEC and IES were significantly more common in MSA than in elderly subjects without MSA. MSA severity is associated with the development of ADPEC. The data suggest that esophageal motility is predominantly affected in MSA. 3 Laryngoscope, 131:832-838, 2021.

Proximal esophageal contraction after induction of ineffective distal contraction by sildenafil in healthy volunteers.

Background:Proximal esophagus is composed of striated muscle replaced by smooth muscle in the distal section. Sildenafil, an inhibitor of phosphodiesterase type 5, causes a decrease in the amplitude of contractions in distal smooth muscle esophagus, with no effect on the proximal esophageal striated muscle. The aim of this investigation was to evaluate the hypothesis that proximal contractions are affected by changes in distal contractions caused by sildenafil.Methods:Esophageal motility was assessed by high resolution manometry in 22 healthy volunteers (12 women) aged 22-50 years (mean 38.1±7.7 years). All volunteers performed, in the sitting position, 10 swallows of liquid (5 mL of saline) and 10 swallows of solid boluses (1 cm3 pieces of bread), before and after ingestion of 50 mg of sildenafil. We evaluated the proximal esophageal contractions in response to the changes in distal esophageal motility induced by sildenafil.Results:Sildenafil caused a significant reduction in distal contractile integral and integrated relaxation pressure in the lower esophageal sphincter. In the proximal esophagus the alteration in distal esophageal contraction caused a significant increase in contraction length, contractile integral, and contraction duration.Conclusion:Induction of ineffective distal esophageal motility by sildenafil in healthy volunteers causes an increase in proximal esophageal motility, suggesting that proximal esophagus adapts to an induced impairment of distal esophageal motility.

High Resolution Manofluorographic Study in Patients With Multiple System Atrophy: Possible Early Detection of Upper Esophageal Sphincter and Proximal Esophageal Abnormality.

Introduction: Multiple system atrophy (MSA) has detrimental effects on swallowing function. The swallowing function of patients with MSA has not been systematically characterized and the underlying pathophysiological mechanisms of dysphagia remain poorly understood.Objectives: To investigate the characteristics of swallow function in MSA using high-resolution manofluorography (HRMF).Methods: We conducted a retrospective review of twenty-five MSA patients who underwent HRMF from 2016 to 2017. HRMF was utilized on patients with only oral diet (Functional Oral Intake Scale (FOIS) >3). Pharyngoesophageal and proximal esophageal pressure profiles were evaluated and compared to established normative data. The frequency and characteristics of upper esophageal sphincter (UES) and proximal esophageal abnormalities during rest and swallow were calculated.Results: The ages of patient cohort in our study ranged from 48–81 years (median 65 years) with male predominance (68%). We observed a distinct abnormal deglutitive proximal esophageal contraction (ADPEC) in 14 (56% of patients), which appears to reflect a discoordinated response of the striated muscle esophagus. Deficient UES relaxation duration, impaired UES relaxation, hypertensive resting UES pressure and hypotensive resting UES pressure were detected in 8 patients (32%), 3 patients (12%), 1 patient (4%), and 11 patients (44%) respectively.Conclusions: In patients with MSA, abnormal UES resting pressure is common. A discoordinated proximal esophageal pressure response was identified and may be a pathognomonic manometry finding for MSA. These findings may serve as indications of early stage swallowing dysfunction in patients with MSA.

Myotomy of Distal Esophagus Influences Proximal Esophageal Contraction and Upper Esophageal Sphincter Relaxation in Patients with Achalasia After Peroral Endoscopic Myotomy.

Background/AimsThe motility change after peroral endoscopic myotomy (POEM) in achalasia is currently focused on lower esophageal sphincter (LES). This study aims to investigate the correlation of motility response between distal and proximal esophagus after POEM.MethodsA total of 32 achalasia patients who received POEM and high-resolution manometry (HRM) were included for analysis. Eckardt score was used to assess symptom improvement. HRM was applied for studying motility. Main parameters analyzed were (1) LES: resting pressure (restP), 4-second integrated relaxation pressure; (2) esophageal body (EB): contractile integral of distal segment with myotomy (CI-DM) and proximal segment without myotomy (CI-PNM); and (3) upper esophageal sphincter (UES): relaxation pressure (UES-RP).ResultsThere were 6 type I, 17 type II, and 9 type III achalasia patients included for analysis. (1) Eckardt score, LES tone, CI-DM, CI-PNM and UES-RP were reduced remarkably after POEM (P < 0.001). (2) no significant correlation was noted between LES tone and contractile intergral of EB. (3) a positive linear correlation of CI-DM and CI-PNM changes was detected (P < 0.001). (4) the change of UES-RP was positively correlated with the change of contractile integral of EB (P < 0.001).ConclusionsMyotomy of the distal esophagus would attenuate proximal EB contraction and assist UES relaxation in achalasia patients after POEM.

Tu1452 Dynamics of Pharyngeal Contraction During Vocalization, Cough and Swallowing Maneuvers Using High Resolution Manometry

Background: Efferent control of motor activity in the striated and smooth muscle esophageal segments in man reside in separate brainstem nuclei. These different functional units are readily identifiable on high resolutionmanometry (HRM). Motor responses within the smooth muscle segment are known to be highly variable and dependent upon parameters such as bolus volume. It is unknown whether motor function in the striated muscle segment responds identically to different afferent inputs. Spontaneous swallows provide a platform to study motor variability that is not artificially constrained by prescribed bolus volumes and times of deglutition. Aim: 1) Define the variability and correlation of pressure phenomena during deglutitive UES after-contraction and proximal esophageal contractions and 2) determine concordance of contractile activity in the striated and smooth segments. Methods: Esophageal HRM of 10 young healthy subjects were studied. Temporally isolated dry swallows without interference of bolus transport, and other swallows were chosen for analysis. We analyzed UES and esophageal pressure parameters using smart mouse tool in color contour plots. Esophageal contractile wave segments above and below the transitional zone were identified. Both temporal and amplitude characteristics of UES after-contraction and segmental esophageal contractile pressure waves were recorded. Linear regression analysis was used to determine correlation of pressure parameters. Results: The manometric length of UES, esophageal proximal striated muscle and distal smooth muscle segments were 3 + 0.5, 4 + 1 cm and 13 + 3 cm respectively. There was significant intraand inter-subject variability in contractile parameters in the two striated muscle segments. During the first phase of UES postdeglutitive after-contraction pressure dropped down expeditiously from its peak contraction while during the second phase, UES tone declined back to baseline slowly. Duration and vigor of the first phase of UES post-deglutitive contraction significantly correlated with duration and contraction amplitude of proximal striated esophagus. This correlation did not exist with esophageal smoothmuscle segment.Conclusion:Despite considerable variability in contractile activity from swallow-to-swallow, the motor activity in upper esophageal sphincter and proximal esophageal striated muscle segment is congruous, consistent with a shared locus of control. The lack of correlation between contractility of the esophageal striated and smooth muscle segments is consistent with being served by two different control centers that are not tightly linked in their response to afferent stimuli.

Tu1453 Pharyngeal Bolus Transit in a Human Model of Restricted Swallowing; A Multi-Channel Intraluminal Impedance Study

Background: Efferent control of motor activity in the striated and smooth muscle esophageal segments in man reside in separate brainstem nuclei. These different functional units are readily identifiable on high resolutionmanometry (HRM). Motor responses within the smooth muscle segment are known to be highly variable and dependent upon parameters such as bolus volume. It is unknown whether motor function in the striated muscle segment responds identically to different afferent inputs. Spontaneous swallows provide a platform to study motor variability that is not artificially constrained by prescribed bolus volumes and times of deglutition. Aim: 1) Define the variability and correlation of pressure phenomena during deglutitive UES after-contraction and proximal esophageal contractions and 2) determine concordance of contractile activity in the striated and smooth segments. Methods: Esophageal HRM of 10 young healthy subjects were studied. Temporally isolated dry swallows without interference of bolus transport, and other swallows were chosen for analysis. We analyzed UES and esophageal pressure parameters using smart mouse tool in color contour plots. Esophageal contractile wave segments above and below the transitional zone were identified. Both temporal and amplitude characteristics of UES after-contraction and segmental esophageal contractile pressure waves were recorded. Linear regression analysis was used to determine correlation of pressure parameters. Results: The manometric length of UES, esophageal proximal striated muscle and distal smooth muscle segments were 3 + 0.5, 4 + 1 cm and 13 + 3 cm respectively. There was significant intraand inter-subject variability in contractile parameters in the two striated muscle segments. During the first phase of UES postdeglutitive after-contraction pressure dropped down expeditiously from its peak contraction while during the second phase, UES tone declined back to baseline slowly. Duration and vigor of the first phase of UES post-deglutitive contraction significantly correlated with duration and contraction amplitude of proximal striated esophagus. This correlation did not exist with esophageal smoothmuscle segment.Conclusion:Despite considerable variability in contractile activity from swallow-to-swallow, the motor activity in upper esophageal sphincter and proximal esophageal striated muscle segment is congruous, consistent with a shared locus of control. The lack of correlation between contractility of the esophageal striated and smooth muscle segments is consistent with being served by two different control centers that are not tightly linked in their response to afferent stimuli.

Transition zone defect associated with the response to proton pump inhibitor treatment in patients with globus sensation

Few data describing short-term proton pump inhibitor (PPI) treatment in patients with globus sensation exist. The aim of this study was to evaluate the use of high-resolution manometry (HRM) for predicting the response to PPI treatment in patients with globus sensation. A total of 41 patients with globus sensation were treated with PPIs for 4 weeks and were classified as positive and negative responders. HRM topographical plots were analyzed for relevant manometric parameters. In addition, clinical and HRM data of 20 patients with typical gastroesophageal reflux disease (GERD) not presenting globus symptom were analyzed. Of the 41 patients, 19 (46%) were clinically diagnosed with GERD. The proportion of patients with favorable symptomatic improvement was higher in patients with GERD than in those without reflux (P=0.046). Positive and negative responders to PPI treatment did not differ in upper esophageal sphincter and proximal esophageal contraction. In globus patients with GERD, the temporal and spatial dimension of the transitional zone were greater among negative responders than among PPI-positive responders (P=0.010 and P=0.011). Regarding GERD patients without globus, there was no significant difference in transition zone defect according to PPI responsiveness. By receiver operating characteristic curve analysis, 2.1 cm and 1.1 s were found to be the spatial and temporal transitional zone dimensions that best differentiated positive and negative responders. In patients with GERD-related globus, there were larger transition zone defect in the negative responders compared with the PPI-positive responders.

Presentation, Diagnosis, and Management of Achalasia

Presentation, Diagnosis, and Management of Achalasia

Normative values of the esophageal manometry and its influential factors in the healthy subjects: a multiple center study in China

Objective To establish normative values of esophageal manometry in different age groups and standard test method.Methods The values of esophageal manometry were tested in healthy subjects of 3 different age groups (Group Ⅰ: 18-39 years,Group Ⅱ: 40-59 years,Group Ⅲ:≥60 years) with pneumohydraulic capillary perfusion system.The repeatability and stability of this method in lower esophageal sphincter (LES) testing were observed. Results There were no significant differences of LES length (LESL),LES pressure (LESP) at the end of expiration,average LESP,residual pressure of LES and LES relaxation rate (LESRR) in three groups (P＞0.05).The LESP at the end of inspiration in Group Ⅰ (28.98± 1.11 ) mm Hg was significantly lower than that of Group Ⅲ (34.35±1.96) mm Hg (P＜0.05).Trandiaphragmatic pressure (Pdi) in Group Ⅰ (9.55±0.62) mm Hg was significantly lower than that of Group Ⅱ (13.05±0.76) mm Hg (P＜0.05).There were no significant differences in contraction amplitude and duration of proximal and distant esophagus in 3 groups (P＞0.05).UES pressure (UESP) of Group Ⅲ was significantly lower than that of Group Ⅰ and Ⅱ (P＜0.05).As for repeatability,the second recording of LESP in Group Ⅰ and Ⅱ were significantly higher than first recording (P＜0.05).Amplitude of distant esophageal peristaltic contraction (DEPC) of female was significantly higher than of male (P＜0.05).However,there was no significant difference in amplitude of proximal esophageal peristaltic contraction (PEPC)between femal and male (P＞0.05).Conclusions The normative values of esophageal manometry in different age groups have been obtained.The dynamic parameters of LES do not change with age.Between age 40 to 59 years old,the contraction of esophageal body is strongest.UESP decreases significantly in old people.If the subjects have enough time to adapt before test,it will help to get accurate and reliable dynamic parameters of LES. Key words: Esophageal sphincter, lower; Age factors; Esophageogastric junction; manometry; Peristalsis

Effect of age on proximal esophageal response to swallowing

It has been demonstrated that the ageing process affects esophageal motility. To evaluate the effect of the age on the proximal esophageal response to wet swallows. We measured the proximal esophageal response to swallows of a 5 mL bolus of water in 69 healthy volunteers, 20 of them aged 18-30 years (group I), 27 aged 31-50 years (group II), and 22 aged 51-74 years (group III). We used the manometric method with continuous perfusion. The proximal esophageal contractions were recorded 5 cm from a pharyngeal recording site located 1 cm above the upper esophageal sphincter. The time between the onset of the pharyngeal and of the proximal esophageal recording (pharyngeal-esophageal time) and the amplitude, duration and area under the curve of the proximal esophageal contraction were measured. The pharyngeal-esophageal time was shorter in group I subjects than in group II and III subjects (P<0.05). The duration of proximal esophageal contractions was longer in group I than in groups II and III (P<0.001). There was no differences between groups in the amplitude or area under the curve of contractions. There were no differences between groups II and III for any of the measurements. We conclude that the age may affects the response of the proximal esophagus to wet swallows.

Effect of bolus volume on proximal esophageal contractions of patients with Chagas' disease and patients with idiopathic achalasia

Chagas' disease and idiopathic achalasia patients have similar impairment of distal esophageal motility. In Chagas' disease, the contractions occurring in the distal esophageal body are similar after wet or dry swallows. Our aim in this investigation was to evaluate the effect of wet swallows and dry swallows on proximal esophageal contractions of patients with Chagas' disease and with idiopathic achalasia. We studied 49 patients with Chagas' disease, 25 patients with idiopathic achalasia, and 33 normal volunteers. We recorded by the manometric method with continuous water perfusion the pharyngeal contractions 1 cm above the upper esophageal sphincter and the proximal esophageal contractions 5 cm from the pharyngeal recording point. Each subject performed in duplicate swallows of 3-mL and 6-mL boluses of water and dry swallows. We measured the time between the onset of pharyngeal contractions and the onset of proximal esophageal contractions (pharyngeal-esophageal time [PET]), and the amplitude, duration, and area under the curve (AUC) of proximal esophageal contractions. Patients with Chagas' disease and with achalasia had longer PET, lower esophageal proximal contraction amplitude, and lower AUC than controls (P≤ 0.02). In Chagas' disease, wet swallows caused shorter PET, higher amplitude, and higher AUC than dry swallows (P≤ 0.03).There was no difference between swallows of 3- or 6-mL boluses. There was no difference between patients with Chagas' disease and with idiopathic achalasia. We conclude that patients with Chagas' disease and with idiopathic achalasia have a delay in the proximal esophageal response and lower amplitude of the proximal esophageal contractions.

T1890 The Effect of ‘Physiologic Challenge’ on Coordination Between Proximal and Distal Esophageal Contractions in Healthy Volunteers

T1890 The Effect of ‘Physiologic Challenge’ on Coordination Between Proximal and Distal Esophageal Contractions in Healthy Volunteers

Gender differences in proximal esophageal contractions

There are reports showing that gender has an influence on swallowing and on the contractions of the distal esophageal body. In this investigation we studied the effect of gender on proximal esophageal contraction. We studied 20 men (22-68 years old, median 39 years) and 44 women (18-61 years old, median 41 years) without symptoms and without gastrointestinal or respiratory diseases. We measured the time interval between the onset of pharyngeal contraction 1 cm proximal to the upper esophageal sphincter and the onset of the proximal esophageal contraction 5 cm from the pharyngeal recording. We also measured the amplitude, duration and area under the curve of the proximal esophageal contractions. The recording was performed by the manometric method with continuous perfusion. The contractions were recorded in duplicate after swallows of a 5 mL bolus of water. There were no differences between men and women in the interval between the onset of pharyngeal and of esophageal contractions or in the amplitude of esophageal contractions. The duration of contractions was longer in women (2.35 +/- 0.60 s) than in men (2.07 +/- 0.62 s) but the difference did not reach statistical significance (P = 0.087). The area under the curve of the esophageal contraction was higher in women (130.2 +/- 55.2 mm Hg x s) than in men (97.4 +/- 49.4 mm Hg x s, P = 0.026). We conclude that there is a difference between men and women in the proximal esophageal contractions in response to wet swallows, although this difference is of no clinical relevance.

Clinical measurement of swallowing and proximal esophageal contractions in Chagas’ disease

Background Chagas’ disease causes esophageal motility impairment similar to that seen in idiopathic achalasia. Our hypothesis is that the disease could affect the results of swallowing evaluation and the esophageal response to swallows.

Characteristics of the Esophageal Low-Pressure Zone in Healthy Volunteers and Patients With Esophageal Symptoms: Assessment by High-Resolution Manometry

Esophageal motility studies in humans have documented a low-pressure zone (LPZ) in the area of transition from striated to smooth muscle. While preliminary studies indicate that a bolus might be retained in this area, the clinical relevance of the LPZ remains unclear. To investigate a possible relationship between esophageal symptoms and the size of the esophageal LPZ. We reviewed high-resolution manometry (HRM) data from patients with esophageal symptoms (dysphagia, chest pain, and heartburn/regurgitation) and asymptomatic volunteers. The proximal border of the LPZ was defined as the point where the amplitude of the proximal contraction wave declined below 30 mmHg, and the distal border as the point where the distal contraction wave first increased above 30 mmHg. The average (+/- standard error of mean [SEM]) length of the LPZ in 44 asymptomatic individuals was 5.4 +/- 0.6 cm and did not differ (P= 0.222) from the LPZ in 64 patients with dysphagia (6.8 +/- 0.4 cm), 34 patients with chest pain (6.4 +/- 0.6 cm), and 42 patients with gastroesophageal reflux disease (GERD) symptoms (7.0 +/- 0.6 cm). These results did not change when the length of the LPZ was corrected for total esophageal length. The time width of the LPZ in asymptomatic individuals (1.6 +/- 0.2 s) was shorter than in patients with dysphagia and GERD symptoms (dysphagia 2.4 +/- 0.2 s, GERD symptoms 2.8 +/- 0.3 s). A time delay between the proximal and distal esophageal contraction waves might be a meaningful variable in GERD and dysphagia.

Differences in response of the proximal esophagus to wet swallows in patients of Chagas’ disease and idiopathic achalasia

Chagas' disease and idiopathic achalasia have similar esophageal manifestations such as absent or incomplete lower esophageal sphincter relaxation and aperistalsis in the esophageal body (alterations seen mainly in the distal esophageal body). Our aim in this paper was to study the response of the proximal esophageal body to wet swallows in patients with Chagas' disease and patients with idiopathic achalasia. We retrospectively analyzed the time interval between the onset of the pharyngeal contractions 1 cm proximal to the upper esophageal sphincter, as well as 5 cm distal to the pharyngeal measurement. Amplitude, duration and area under the curve of contractions in the proximal esophagus were also determined in 42 patients with Chagas' disease (15 with associated esophageal dilatation), 21 patients with idiopathic achalasia (14 with concomitant esophageal dilatation) and 31 control subjects. The time between the onset of pharyngeal and proximal esophageal contractions was longer in patients with Chagas' disease and in those with esophageal dilatation (1.39 +/- 0.16 s) than in control subjects (0.86 +/- 0.04 s, P < 0.01). The amplitude of proximal esophageal contractions was lower in patients with idiopathic achalasia and esophageal dilatation (60.9 +/- 16.3 mmHg) than in control subjects (89.7 +/- 6.9 mmHg, P = 0.06). The authors conclude that in patients with advanced esophageal disease, the proximal esophageal contractions in Chagas' disease have a delayed response to wet swallows when compared with controls, and that the amplitude of proximal esophageal contractions was lower than expected in patients with idiopathic achalasia.

Relação entre idade e motilidade do esôfago em pacientes com doença do refluxo gastroesofágico

Alterations of esophageal contractions may worsen the esophageal lesions caused by gastroesophageal reflux. The impairment of the contractions may be localized only in the distal esophagus or in the entire esophageal body, and may be worse with the aging process. To evaluate the proximal and distal esophageal contractions in patients with gastroesophageal reflux symptoms with or without esophagitis. We studied esophageal motility in 104 patients with gastroesophageal reflux symptoms, 42 with normal esophageal endoscopic examination, 47 with mild esophagitis and 15 with severe esophagitis. The esophageal contractions were measured by the manometric method at 2, 7, 12 and 17 cm from the upper esophageal sphincter, after five swallows of a 5 mL bolus of water. The amplitude and area under the curve of contractions were lower in patients with severe esophagitis than in patients without esophagitis or with mild esophagitis in the distal part of the esophageal body (17 cm from the upper esophageal sphincter). In the proximal esophageal body there was no difference in amplitude or area under the curve. In the entire esophageal body there was no difference between the three groups of patients in duration, velocity of peristaltic contractions, or proportion of failed, simultaneous, non-propagated or peristaltic contractions. There was no difference between the patients with less than 50 years or with more than 50 years of age. Patients with severe esophagitis had lower distal esophageal contraction amplitude than patients without esophagitis or with moderate esophagitis. There was no effect of aging on esophageal contractions.

Proximal Esophageal Contractions in Laryngectomized Patients

After laryngectomy for treatment of laryngeal cancer, the distal esophageal contractions have low amplitude. Our hypothesis is that proximal esophageal contractions are also impaired. We studied the proximal esophageal contractions in 20 laryngectomized patients (16 men) with a mean age of 44.2 years, 12 rehabilitated patients with esophageal speech, and 12 controls (7 men, mean age of 46.5 years). We used the manometric method with continuous perfusion. All subjects were studied in the sitting position and performed five swallows of a 5-ml bolus of water alternated with five dry swallows. The contractions were measured 2 cm below the high-pressure zone of the pharyngoesophageal transition. The results showed that the amplitude and duration of contractions were different in laryngectomized patients compared with controls. The amplitude of contractions of patients (wet swallows: 37.3+/-20.7 mmHg, mean+/-SD) was lower than that of controls (81.1+/-31.7 mmHg). The duration of contractions was also lower in laryngectomized patients (2.2+/-0.7 s) than in controls (2.6+/-0.6 s). We conclude that the proximal esophageal contraction amplitude and duration of laryngectomized patients are lower than controls, a fact suggesting that laryngectomy may affect the proximal esophageal contractions.

Proximal and distal esophageal contractions in patients with vigorous or classic esophageal Chagas' disease

Some patients with achalasia have distal esophageal contraction amplitude in the normal range, a condition called vigorous achalasia, and others have low contraction amplitude, a condition named classic achalasia. The difference in distal contraction amplitude may also be associated with a difference in proximal contraction amplitude. To study the proximal and distal esophageal contractions in patients with Chagas' disease. We studied 28 patients with Chagas' disease, all with dysphagia and an esophageal radiologic examination with retention without dilation, and 18 controls. The patients with Chagas' disease had vigorous achalasia (distal amplitude over 34 mm Hg, n = 13) or classic achalasia (distal amplitude below 34 mm Hg, n = 15). We measured the contractions by the manometric method with continuous perfusion at 2, 7, 12 and 17 cm below the upper esophageal sphincter after five swallows of a 5 mL bolus of water. There was no difference in proximal amplitude of contractions between classic or vigorous achalasia, and controls. In the proximal esophagus there was also no difference in duration or area under curve of contractions. In the distal esophagus, duration and area under curve were lower in classic than vigorous disease. Failed and simultaneous contractions were more frequent in patients than controls. Simultaneous contractions were seen more frequently in classic disease, and peristaltic contractions were seen more frequently in vigorous disease. We did not find differences in proximal esophageal contractions of patients with classical or vigorous esophageal Chagas' disease, except for the higher number of simultaneous contractions seen in classic disease.