No abstract available.
Esophageal Achalasia ; Humans ; Swallows ; Water

OBJECTIVE: The aim of the study is to evaluate the changes of the respiratory patterns associated with swallowing in the brain-injured patients. METHOD: Twenty brain-injured patients(6 bulbar lesions, 14 pseudobulbar lesions) and fifteen normal subjects were selected for this study. Each subject swallowed 5cc of water for ten times in a upright sitting position and a submental electromyography recording and respirography by pneumobelt on mid-abdomen were recorded simultaneously. RESULTS: 1) Most swallows occured during the late expiratory phase in both brain-injured patients and controls. 2) In brain-injured patients, the incidence of swallowing during inspiration was significantly higher than the controls(p<0.05). 3) In brain-injured patients, the postdeglutitive inspiration was significantly higher than the controls(p<0.05). 4) In patients with a bulbar lesion, the postdeglutitive inspiration was significantly higher than patients with a pseudobulbar lesion(p<0.01). 5) Postdeglutitive swallowing relatively correlates with the abnormalities in clinical findings and Video Fluoroscopic Swallowing Study(VFSS) findings. CONCLUSION: The respiratory patterns associated with the swallowing in brain-injured patients were different from that of the normal adults and the postdeglutitive inspiration could be the most valuable predictor of the aspiration.
Adult ; Deglutition* ; Electromyography ; Humans ; Incidence ; Swallows ; Water

BACKGROUND/AIMS: We used high-resolution impedance manometry (HRIM) to determine the length of breaks on the isobaric contour which would predict incomplete bolus clearance in patients in the sitting position. METHODS: In total, 651 swallows in 71 patients with esophageal symptoms were studied using a solid-state HRIM system in the sitting position. Each swallow was classified as complete or incomplete bolus clearance by impedance criteria and peristaltic integrity was evaluated using 20- and 30-mmHg pressure topography isobaric contours. Correlations between the lengths of the breaks for 20- and 30-mmHg were analyzed. RESULTS: Complete bolus clearance was observed in 83.3% (542/651) of swallows. Breaks of 3 and 7 cm or less were associated with a bolus clearance of 96.8% on the 20-mmHg and 94.7% on the 30-mmHg isobaric contour, respectively (P < 0.001). The areas under the ROC curves for the 20 and 30 mmHg isobaric contours were 0.900 and 0.950, respectively. The sensitivity and specificity for complete bolus clearance were 75.6% and 89.3% for breaks 3 cm or less on the 20-mmHg isobaric contour and 87.9% and 78.7% for breaks 7 cm or less on the 30-mmHg contour (P < 0.001). CONCLUSIONS: Breaks of < 3 cm in the 20-mmHg isobaric contour or < 7 cm in the 30-mmHg isobaric contour were associated with com -plete bolus clearance. The threshold for breaks in the sitting position was greater than previous reports using the supine position and longer breaks predicted incomplete bolus clearance.
Electric Impedance* ; Humans ; Manometry* ; ROC Curve ; Sensitivity and Specificity ; Supine Position ; Swallows

BACKGROUND/AIMS: Most recent studies using high-resolution manometry were based on supine liquid swallows. This study was to evaluate the differences in esophageal motility for liquid and solid swallows in the upright and supine positions, and to determine the percentages of motility abnormalities in different states. METHODS: Twenty-four asymptomatic volunteers and 26 patients with gastroesophageal reflux disease underwent high-resolution manometry using a 36-channel manometry catheter. The peristalses of 10 water and 10 steamed bread swallows were recorded in both supine and upright positions. Integrated relaxation pressure, contractile front velocity, distal latency (DL) and the distal contractile integral (DCI) were investigated and comparisons between postures and boluses were analyzed. Abnormal peristalsis of patients was assessed applying the corresponding normative values. RESULTS: In total, 829 swallows from healthy volunteers and 959 swallows from patients were included. (1) The upright position provided lower integrated relaxation pressure, shorter DL and weaker DCI than the supine position. (2) In the comparison of liquid swallows, the mean for contractile front velocity was obviously reduced while DL and DCI were increased in solid swallows. (3) The supine position detected more hypotensive peristalsis than the upright position. The upright position provided more rapid and premature contraction than the supine position but there was no statistically significant difference. CONCLUSIONS: Supine solid swallows occur with more hypotensive peristalsis. Analysis should be based on normative values from the corresponding posture and bolus.
Bread ; Catheters ; Esophageal Motility Disorders ; Gastroesophageal Reflux ; Humans ; Manometry* ; Peristalsis ; Posture ; Relaxation ; Supine Position ; Swallows* ; Water

BACKGROUND/AIMS: Swallowing of cold liquids decreases amplitude and velocity of peristalsis in healthy subjects, using standard manometry. Patients with achalasia and non obstructive dysphagia may have degeneration of sensory neural pathways, affecting motor response to cooling. To elucidate this point, we used high-resolution manometry. METHODS: Fifteen healthy subjects, 15 non-obstructive dysphagia and 15 achalasia patients, after pneumatic dilation, were studied. The 3 groups underwent eight 5 mL single swallows, two 20 mL multiple rapid swallows and 50 mL intraesophageal water infusion (1 mL/sec), using both water at room temperature and cold water, in a randomized order. RESULTS: In healthy subjects, cold water reduced distal contractile integral in comparison with water at room temperature during single swallows, multiple rapid swallows and intraesophageal infusion (ratio cold/room temperature being 0.67 [95% CI, 0.48-0.85], 0.56 [95% CI, 0.19-0.92] and 0.24 [95% CI, 0.12-0.37], respectively). A similar effect was seen in non-obstructive dysphagia patients (0.68 [95% CI, 0.51-0.84], 0.69 [95% CI, 0.40-0.97] and 0.48 [95% CI, 0.20-0.76], respectively), whereas no changes occurred in achalasia patients (1.06 [95% CI, 0.83-1.29], 1.05 [95% CI, 0.77-1.33] and 1.41 [95% CI, 0.84-2.00], respectively). CONCLUSIONS: Our data suggest impairment of esophageal reflexes induced by cold water in patients with achalasia, but not in those with non obstructive dysphagia.
Deglutition ; Deglutition Disorders* ; Esophageal Achalasia* ; Humans ; Manometry* ; Neural Pathways ; Peristalsis ; Reflex ; Swallows ; Water*

BACKGROUND/AIMS: High-resolution manometry (HRM), with a greatly increased number of recording sites and decreased spacing between sites, allows evaluation of the dynamic simultaneous relationship between intrabolus pressure (IBP) and esophagogastric junction (EGJ) relaxation pressure. We hypothesized that bolus transit may occur when IBP overcomes integrated relaxation pressure (IRP) and analyzed the relationships between peristalsis pattern and the discrepancy between IBP and IRP in patients with dysphagia. METHODS: Twenty-two dysphagia patients with normal EGJ relaxation were examined with a 36-channel HRM assembly. Each of the 10 examinations was performed with 20 and 30 mmHg pressure topography isobaric contours, and findings were categorized based on the Chicago classification. We analyzed the relationships between peristalsis pattern and the discrepancy between IBP and IRP. RESULTS: Twenty-two patients were classified by the Chicago classification: 1 patient with normal EGJ relaxation and normal peristalsis, 8 patients with intermittent hypotensive peristalsis and 13 patients with frequent hypotensive peristalsis. A total of 220 individual swallows were analyzed. There were no statistically significant relationships between peristalsis pattern and the discrepancy between IBP and IRP on the 20 or 30 mmHg isobaric contours. CONCLUSIONS: Peristalsis pattern was not associated with bolus transit in patients with dysphagia. However, further controlled studies are needed to evaluate the relationship between bolus transit and peristalsis pattern using HRM with impedance.
Classification ; Deglutition Disorders* ; Electric Impedance ; Esophageal Motility Disorders ; Esophagogastric Junction* ; Humans ; Manometry ; Peristalsis ; Relaxation ; Swallows

Diffuse esophageal spasm (DES) is a motility disorder of the esophagus characterized by symptoms of retrosternal chest pain and intermittent dysphagia. The diagnosis of DES has relied on criteria obtained from a standard esophageal manometry (more than one simultaneous contraction in a series of 10 wet swallows with the rest being peristaltic). Because symptoms and/or typical manometric findings are not always documented during the standard manometry, 24 hour manometry may be more useful in such cases. We recently assessed a 29-year-old male patient who complained of chest pain and dysphagia. He showed nonspecific findings on the laboratory based manometry, but DES was diagnosed by his typical manometric findings on the 24 hour manometry. Therefore, a 24 hour manometry should always be performed when the patient's history suggests the presence of DES and the laboratory based manometry failed to detect the symptomatic contractions of DES. Following we report this case with a review of the literature.
Adult ; Chest Pain ; Deglutition Disorders ; Diagnosis* ; Esophageal Spasm, Diffuse* ; Esophagus ; Humans ; Male ; Manometry* ; Swallows

PURPOSE: The aim of this study is to estimate one mouthful volume in a single swallow and average volume per swallow (AVS) in multiple swallows in the situation of toxic liquid poisoning. METHODS: Thirty five men and 35 women were included in this study. Each subject was asked to drink one swallow and three consecutive swallows from bottle containing water and a bottle containing saline separately. We calculated one mouthful volume in a single swallow and AVS in three swallows. One mouthful volume and AVS were compared according to sex and content, respectively. One mouthful volume of water and saline was then compared with AVS of each. RESULTS: Sixty seven adults(34 men; 26.9+/-3.2 years, 33 women; 25.6+/-2.4 years) completed the study. Men had larger one mouthful volume of water(49.1+/-19.9 ml vs 39.7+/-10.2 ml, p=0.02) and saline(20.7+/-10.9 ml vs 14.0+/-4.6 ml, p=0.004) and AVS of water(28.5+/-11.9 ml vs 21.5+/-5.9 ml, p=0.004) and saline(11.9+/-6.3 ml vs 7.9+/-2.0 ml, p=0.001) than women. One mouthful volume and AVS of saline swallow were lower than those of water swallow. AVS of three consecutive swallows was lower than one mouthful volume in water and saline swallow. CONCLUSION: We suggest that one mouthful volume in a single swallow is 21 ml in men and 14 ml in women and AVS in multiple swallows is 12 ml in men and 8 ml in women. AVS in multiple swallows is two-threefold lower than reference values(20~30 ml) commonly used in poisoning study.
Adult ; Deglutition* ; Female ; Humans ; Male ; Mouth ; Poisoning ; Swallows ; Water ; Young Adult*

Esophageal manometry is considered the gold standard for assessing esophageal motor function. Although conventional manometry has been widely used to evaluate esophageal motor function, this is not fully satisfactory for explaining esophageal symptoms. High-resolution manometry (HRM) is designed to overcome the limitations of conventional manometric systems with advanced technologies. A solid-state HRM assembly with 36 solid-state sensors spaced at 1 cm intervals (Sierra Scientific Instruments Inc., Los Angeles, CA, USA) has been widely used around the world. Calibration and post-study thermal correction should be performed at each test. The HRM assembly was passed transnasally and positioned to record from the hypopharynx to the stomach. After a 5 minutes resting period to assess basal sphincter pressure, 5 mL water swallows are obtained in a supine posture. The interpretation of HRM data is still being refined. Recently, the HRM Classification Working Group revised the Chicago classification based on a systematic analysis of motility patterns in 75 control subjects and 400 consecutive patients. The below will show you a summary of the new Chicago classification of distal esophageal motility disorders to provide a practical way of interpreting HRM.
Calibration ; Chicago ; Esophageal Motility Disorders ; Esophagogastric Junction ; Humans ; Hypopharynx ; Los Angeles ; Manometry ; Posture ; Stomach ; Swallows ; Water

BACKGROUND/AIMS: Swallowing is a complex function with the control of the swallowing center being located in the brain stem. Our aim in this investigation was to evaluate, in healthy volunteers, the oral and pharyngeal transit of 2 bolus volumes and 2 consistencies, and the influence of these boluses on the proportion of pharyngeal clearance duration/hyoid movement duration. METHODS: Videofluoroscopic evaluation of swallows was performed in 30 healthy volunteers, aged 29-77 years (mean 58 years). The subjects swallowed in duplicate of 5 mL and 10 mL of thick liquid barium and honey thick barium. We measured the duration of oral transit, pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement, oropharyngeal transit, and the relation pharyngeal clearance duration/hyoid movement duration. RESULTS: A 10 mL bolus volume caused a longer UES opening duration than a 5 mL bolus volume, for both consistencies. The pharyngeal transit was longer for honey thick bolus consistency than for thick liquid, with both the volumes of 5 mL and 10 mL. For pharyngeal clearance, the difference was significant only with the 10 mL bolus volume. There was no difference associated with bolus volume or consistency in the relation between pharyngeal clearance duration and hyoid movement duration. CONCLUSIONS: Increase in the swallowed bolus volume causes a longer UES opening duration and an increase in bolus consistency from thick liquid to honey thick causes a longer pharyngeal transit duration. The proportion between pharyngeal clearance and hyoid movement does not change with bolus volume or bolus consistency.
Barium ; Brain Stem ; Deglutition* ; Esophageal Sphincter, Upper ; Healthy Volunteers ; Honey ; Pharynx ; Swallows