4.6 Review

Distension contraction plots of pharyngeal/esophageal peristalsis: next frontier in the assessment of esophageal motor function

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Summary: Intraluminal impedance recordings can measure luminal distension in the esophagus. Factors such as posture and bolus viscosity affect bolus flow rate, esophageal wall tension, and esophageal wall distensibility during swallow-induced primary peristalsis.

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Summary: Translating: In oropharyngeal dysphagia, impaired pharyngoesophageal junction (PEJ) opening is reflected by an elevated hypopharyngeal intrabolus pressure (IBP), quantifiable using pharyngeal high-resolution manometry with impedance (P-HRM-I). Transient intrabolus pressurization (TP) phenomena are not sustained and last for only a brief period. We hypothesized that TP patterns reflect impaired coordination between timing of hypopharyngeal bolus arrival and PEJ relaxation. Chinese Summary: Transient intrabolus pressurization (TP) in oropharyngeal dysphagia reflects mistimed coordination between bolus arrival and PEJ relaxation, with higher IBP and shorter PEJ relaxation time during TP swallows. In Patients, RT-DCL time difference correlated with IBP, suggesting pathological TP swallows impede bolus flow due to mistimed coordination. English Summary: In oropharyngeal dysphagia, transient intrabolus pressurization (TP) patterns may indicate impaired coordination between bolus arrival and PEJ relaxation, leading to an increased IBP and shorter PEJ relaxation time during TP swallows. The mistimed coordination in TP swallows may impede bolus flow and result in a brief period of pharyngeal chamber pressurization by muscular forces, with IBP correlating with RT-DCL time difference in Patients.

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Rhythmic contraction but arrhythmic distension of esophageal peristaltic reflex in patients with dysphagia

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Summary: Patients with unexplained dysphagia show abnormalities in the distension phase of esophageal peristalsis, with faster bolus transit, smaller luminal cross-sectional area, and fragmented bolus flow compared to normals. These abnormalities are sensitive and specific markers of dysphagia, suggesting that the cause of dysphagia sensation may be due to esophageal contraction forcing the bolus through a narrow lumen esophagus.

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Esophageal Bolus Domain Pressure and Peristalsis Associated With Experimental Induction of Esophagogastric Junction Outflow Obstruction

Wei-Yi Lei et al.

Summary: This study measured the effect of esophageal outflow obstruction induced by a leg-lift protocol on intrabolus pressures. The results showed an increase in relaxation pressure and distal contractile integral at the esophagogastric junction, as well as increased pressures in all bolus categories. Measuring pressures within the intrabolus domain can aid in confirming a diagnosis of EGJ outflow obstruction.

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Summary: This study found that EGJOO patients with abnormal EBM are more likely to experience esophageal symptoms, indicating that abnormal EBM may impact the clinical presentation of EGJOO.

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Summary: This study compared novel gel bolus with other materials for impedance-based luminal distension measurement during swallowing-induced peristalsis. The novel gel bolus showed the least amount of air in the bolus during passage through the esophagus and had the best correlation between US measured CSA and nadir impedance value in both supine and Trendelenburg positions. Using the novel gel bolus is suggested for assessing distension and contraction during routine clinical HRM testing.

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Summary: The study found that patients with nutcracker esophagus have smaller amplitudes of distension and contraction during swallow-induced peristalsis compared to normal subjects, but greater amplitude of contraction. Additionally, there are abnormalities in the temporal relationship between distension and contraction in patients, which may contribute to dysphagia.

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Summary: EGJOO is defined as an elevated IRP and IBP during wet swallows and persistently elevated IRP in the upright position according to CCv4. A conclusive diagnosis requires a manometric diagnosis of EGJOO and associated symptoms supported by additional investigations, with history and endoscopic evaluation being crucial for excluding secondary causes. Proposed changes in CC4.0 aim to improve specificity of diagnosis and reduce clinically irrelevant diagnoses.

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