BACKGROUND/AIMS: The 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. METHODS: A 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). RESULTS: There 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). CONCLUSIONS: Myotomy of the distal esophagus would attenuate proximal EB contraction and assist UES relaxation in achalasia patients after POEM.
Esophageal Achalasia* ; Esophageal Sphincter, Lower ; Esophageal Sphincter, Upper* ; Esophagus* ; Humans ; Manometry ; Relaxation*

BACKGROUND/AIMS: Disturbances of esophageal motility have been reported to be more frequent the aged population. However, the physiology of disturbances in esophageal motility during aging is unclear. The aim of this study was to evaluate the effects of age on esophageal motility using high-resolution esophageal impedance manometry (HRIM). METHODS: Esophageal motor function of 268 subjects were measured using HRIM in 3 age groups, < 40 years (Group A, n = 32), 40–65 years (Group B, n = 185), and > 65 years (Group C, n = 62). Lower esophageal sphincter (LES) and upper esophageal sphincter (UES) pressures, integrated relaxation pressure, distal contractile integral, contractile front velocity, distal latency, and pressures and duration of contraction on 4 positions along the esophagus, and complete bolus transit were measured. RESULTS: Basal UES pressure was lower in Group C (P < 0.001) but there was no significant difference in the LES pressure among groups. Contractile duration on position 3 (10 cm from proximal LES high pressure zone) was longer in Group C (P = 0.001), and the contractile amplitude on position 4 (5 cm from proximal LES high pressure zone) was lower in Group C (P = 0.005). Distal contractile integral was lower in Group C (P = 0.037). Contractile front velocity (P = 0.015) and the onset velocity (P = 0.040) was lower in Group C. There was no significant difference in impedance values. CONCLUSIONS: The decrease of UES pressure, distal esophageal motility, and peristaltic velocity might be related with esophageal symptoms in the aged population.
Aging ; Electric Impedance* ; Esophageal Sphincter, Lower ; Esophageal Sphincter, Upper ; Esophagus ; Humans ; Manometry* ; Physiology ; Relaxation

BACKGROUND/AIMS: Transient lower esophageal sphincter relaxation (TLESR) is the main mechanism of gastroesophageal reflux disease (GERD). The aim of this study was to investigate the characteristics of transient lower esophageal sphincter movement in patients with or without gastroesophageal reflux by high-resolution manometry (HRM). METHODS: From June 2010 to July 2010, we enrolled 9 patients with GERD (GERD group) and 9 subjects without GERD (control group), prospectively. The manometry test was performed in a semi-recumbent position for 120 minutes following ingestion of a standardized, mixed liquid and solid meal. HRM was used to identify the frequency and duration of TLESR, esophageal shortening length from incomplete TLESR, upper esophageal sphincter (UES) response, and the related esophageal motor responses during TLESR. RESULTS: TLESR occurred in 33 in the GERD group and 34 in the control group after 120 minutes following food ingestion. Duration of TLESR and length of esophageal shortening did not differ between 2 groups. UES pressure increase during TLESR was mostly detected in patients with GERD, and UES relaxation was observed frequently in the control group during TLESR. TLESR-related motor responses terminating in TLESR were predominantly observed in the control group. CONCLUSIONS: Increased UES pressure was noted frequently in the GERD group, suggesting a mechanism for preventing harmful reflux, which may be composed mainly of fluid on the larynx or pharynx. However, patients with GERD lacked the related motor responses terminating in TLESR to promote esophageal emptying of refluxate.
Eating ; Esophageal Sphincter, Lower ; Esophageal Sphincter, Upper ; Esophagus ; Gastroesophageal Reflux ; Humans ; Larynx ; Manometry ; Meals ; Pharynx ; Prospective Studies ; Relaxation

BACKGROUND: The diagnostic criteria of laryngopharyngeal reflux disease (LPRD) is defined differently according to the location of the proximal pH probe: upper esophagus, upper esophageal sphincter (UES) or hypopharynx. Clinically the location of proximal probe is determined by the location of distal probe, which is usually fixed on 5 cm above the lower esophageal sphincter. This study was performed to evaluate the difference in the diagnosis of LPRD between the results from considering the location of the proximal probe and not considering it. METHODS: This study consisted of 76 patients performed esophageal manometry and 24 hour ambulatory pH monitoring of esophagus using the dual probe. According to location of the proximal probe, the patients were divided into 3 groups : upper esophagus, UES and hypopharynx group. Firstly, we used the diagnostic criteria not considering the location of the probe concordantly in all 76 patients : criteria of the upper esophagus, UES and hypopharynx respectively. And then, we used the diagnostic criteria considering the location of the proximal probe. The results were compared. RESULTS: When the diagnostic criteria of upper esophagus was used, 3.9% (3/76) was diagnosed as LPRD. In the case of UES and hypopharynx, 18.4% (14/76) and 38.2% (29/76) was diagnosed as LPRD. When the diagnostic criteria considering the location of the proximal probe was used, 27.6% (21/76) was diagnosed as LPRD. Significant difference was found between the result considering the location of the probe and 3 results not considering it (p<0.01). CONCLUSION: It is thought to be appropriate to use the diagnostic criteria considering the location of the proximal probe for the more accurate diagnosis of LPRD.
Diagnosis ; Esophageal Sphincter, Lower ; Esophageal Sphincter, Upper ; Esophagus ; Humans ; Hydrogen-Ion Concentration* ; Hypopharynx ; Laryngopharyngeal Reflux* ; Manometry ; Monitoring, Ambulatory

OBJECTIVETo examine the esophageal function of neonates by high resolution manometry (HRM), and to provide preliminary data for research on the esophageal function of neonates.

METHODSEsophageal HRM was performed on neonates using a solid-state pressure measurement system with 36 circumference sensors arranged at intervals of 0.75 cm, and ManoView software was used to analyze esophageal peristalsis pattern.

RESULTSEsophageal HRM was performed successfully in 11 neonates, and 126 occurrences of complete esophageal peristalsis were recorded. Complete esophageal peristalsis with pressure increase was recorded in some neonates but most neonates showed a different esophageal peristalsis pattern compared with adults. Some neonates had no relaxation of the upper esophageal sphincter (UES) when pharyngeal muscles contracted in swallowing, some neonates had multiple swallowing without esophageal peristalsis and some neonates had relatively low pressure of esophageal peristalsis. Full-term infants could have relatively low UES pressure and esophageal sphincter (LES) pressure but some preterm infants showed relatively high UES pressure and LES pressure. Longitudinal contraction of the whole esophagus and elevation of LES after swallowing were recorded in some neonates.

CONCLUSIONSEsophageal HRM is safe and tolerable for neonates. HRM shows that esophageal peristalsis after swallowing may not occur or may be incomplete in neonates. The esophageal function of neonates has not yet been developed completely, with large individual differences in esophageal peristalsis. Large sample data are needed for further analysis and research on the esophageal function of neonates.

Deglutition ; physiology ; Esophageal Sphincter, Lower ; physiology ; Esophageal Sphincter, Upper ; physiology ; Esophagus ; physiology ; Female ; Humans ; Infant, Newborn ; Male ; Manometry ; methods ; Peristalsis

BACKGROUND AND OBJECTIVES: High resolution manometry (HRM), a newly developed device that uses 36 channels to plot pressure topography of esophagus, has recently been applied to evaluate the esophageal and upper esophageal sphincter (UES) status; however, its definite role in laryngopharyngeal reflux disease (LPRD) is not well elucidated. The aim of this study was to evaluate clinical usefulness of HRM and to elucidate the association between HRM findings and dysphasia in LPRD patients. SUBJECTS AND METHOD: A total of 56 patients who had been diagnosed LPRD from July 2010 to July 2011 were prospectively enrolled in this study. Patients consisted of 20 men and 36 women, with the mean age of 51.4 years. Every patient performed the questionnaire and HRM examination. A comparative analysis was performed to evaluate the correlation between the HRM results and LPRD. RESULTS: Of 30 patients (53.6%), there were 11 peristaltic dysfunction (19.7%), 6 relaxation impairment of lower esophageal sphincter (LES)(10.7%), 4 diffuse esophageal spasm (7.1%), 4 hypotensive LES (7.1%), 3 Nutcracker esophagus (5.4%), and 2 relaxation impairment of UES (3.6%). The mean distance of UES from the nostril was 17.88+/-2.17 cm and the mean UES basal pressure was 63.10+/-24.49 mm Hg. Differences between the prevalence of abnormal findings shown by HRM and dysphasia symptoms were not statistically significant. CONCLUSION: In this study, a considerable amount of abnormalities in esophageal function were observed using HRM, and thus we think that HRM could provide useful information about esophagus dysfunction in LPRD patients.
Aphasia ; Esophageal Motility Disorders ; Esophageal Spasm, Diffuse ; Esophageal Sphincter, Lower ; Esophageal Sphincter, Upper ; Esophagus ; Female ; Humans ; Laryngopharyngeal Reflux* ; Male ; Manometry* ; Prevalence ; Prospective Studies ; Surveys and Questionnaires ; Relaxation

Alkaline esophagitis is a postoperative complication of a gastrectomy due to gastroesophageal reflux. A lymph-node dissection around the abdominal esophagus, a truncal vagotomy, and dissection to the phrenoesophageal membrane are performed during a radical subtotal gastrectomy, resulting in anatomical and functional changes in the lower esophageal sphincter which is an important structure in the antireflux mechanism. This study evaluated the changes in the esophageal functions and the degree of esophageal reflux before and after a radical subtotal gastrectomy.Ten patients with a relatively early stage of stomach cancer were included, and esophageal manometric studies were performed on all patients before and after the radical subtotal gastrectomy. The pressure and the length of the lower esophageal sphincter and the function of the upper esophageal sphincter were measured. In addition, 24-hour ambulatory esophageal pH monitoring was done before and after the radical subtotal gastrectomy to obtain the percent of the total time for which pH<4, pH>7, and pH>8 and the pre-and post-operative values were compared. There was no significant difference between the pressure and the total abdominal length of the lower esophageal sphincter before the radical subtotal gastrectomy and those after the operation. The pressure in the lower esophageal sphincter was slightly decreased after the operation, but fell within the normal range (pre-op.: 19.7 3.2 mmHg; post-op.: 15.9 5.4 mmHg). There was no increase in the percent of the total time for which pH<4 and pH>8 in the 24-hour ambulatory esophageal pH monitoring. In conclusion, functional changes after a subtotal gastrectomy and alkaline reflux might not be affected by the anatomical derangement due to the surgical procedure itself.
Esophageal pH Monitoring ; Esophageal Sphincter, Lower ; Esophageal Sphincter, Upper ; Esophagitis ; Esophagus ; Gastrectomy* ; Gastroesophageal Reflux ; Humans ; Membranes ; Postoperative Complications ; Reference Values ; Stomach Neoplasms ; Vagotomy, Truncal

Gastroesophageal reflux disease (GERD) is a very common disease, and the prevalence in the general population has recently increased. GERD is a chronic relapsing disease associated with motility disorders of the upper gastrointestinal tract. Several factors are implicated in GERD, including hypotensive lower esophageal sphincter, frequent transient lower esophageal sphincter relaxation, esophageal hypersensitivity, reduced resistance of the esophageal mucosa against the refluxed contents, ineffective esophageal motility, abnormal bolus transport, deficits initiating secondary peristalsis, abnormal response to multiple rapid swallowing, and hiatal hernia. One or more of these mechanisms result in the reflux of stomach contents into the esophagus, delayed clearance of the refluxate, and the development of symptoms and/or complications. New techniques, such as 24-hour pH and multichannel intraluminal impedance monitoring, multichannel intraluminal impedance and esophageal manometry, high-resolution manometry, 3-dimensional high-resolution manometry, enoscopic functional luminal imaging probe, and 24-hour dynamic esophageal manometry, provide more information on esophageal motility and have clarified the pathophysiology of GERD. Proton pump inhibitors remain the preferred pharmaceutical option to treat GERD. The ideal target of GERD treatment is to restore esophageal motility and reconstruct the anti-reflux mechanism. This review focuses on current advances in esophageal motor dysfunction in patients with GERD and the influence of these developments on GERD treatment.
Deglutition ; Electric Impedance ; Esophageal Motility Disorders ; Esophageal Sphincter, Lower ; Esophagogastric Junction ; Esophagus ; Gastroesophageal Reflux ; Gastrointestinal Contents ; Hernia, Hiatal ; Humans ; Hydrogen-Ion Concentration ; Hypersensitivity ; Manometry ; Mucous Membrane ; Peristalsis ; Pharmaceutical Preparations ; Phenobarbital ; Prevalence ; Proton Pump Inhibitors ; Relaxation ; Upper Gastrointestinal Tract

OBJECTIVE: The purpose was to investigate the characteristics of oropharyngeal dysphagia and videofluoroscopic study (VFSS) findings in esophageal diseases. METHOD: We retrospectively reviewed the clinical characteristics and VFSS findings in thirteen patients with esophageal cancer and stricture. Videofluoroscopic parameters of oral, pharyngeal, and esophageal phases were measured. Patients were divided into three groups according to their diseases: Group A, esophageal cancer with esophagectomy (5 patients); Group B, esophageal cancer with non-operative treatment (3 patients); and Group C, esophageal stricture with surgical treatment (5 patients). RESULTS: Group A had vocal cord palsy (VCP) after esophagectomy, and all patients showed poor laryngeal closure and aspiration during swallowing. Group B received radiation therapy prior to VFSS and showed poor laryngeal closure and high pharyngeal residue with aspiration during and after swallowing. Group C received esophagectomy with anastomosis of lower gastrointestinal tract (stomach, jejunum, colon). Most had VCP and showed high pharyngeal residue, stricture of upper esophageal sphincter, and poor oral control with aspiration during and after swallowing. CONCLUSION: Characteristics of dysphagia on VFSS were poor laryngeal closure in operated esophageal cancer patients. In patients of non-operated esophageal cancer and esophageal stricture, high pharyngeal residue and poor laryngeal closure were characterized.
Constriction, Pathologic ; Deglutition ; Deglutition Disorders* ; Esophageal Diseases* ; Esophageal Neoplasms ; Esophageal Sphincter, Upper ; Esophageal Stenosis ; Esophagectomy ; Esophagus ; Humans ; Jejunum ; Lower Gastrointestinal Tract ; Oropharynx ; Retrospective Studies ; Vocal Cord Paralysis

BACKGROUND/AIMS: The aim of this study was to characterize the spectrum of esophageal motor dysfunction after repair of an esophageal atresia with a tracheoesophageal fistula (EATEF). METHODS: This study included 16 patients, aged 0.8 to 13.3 years, who were diagnosed with Gross Type C esophageal atresia and underwent a fistula repair and end to end anastomosis. Esophageal function was evaluated with manometry, 24 hour esophageal pH monitoring, a barium esophagogram, and an endoscopy. RESULTS: Symptoms were present in 8 patients (dysphagia for solid food in 2; frequent vomiting in 6; and poor weight gain in 4). Anastomotic stricture was present in 6 patients. An esophageal manometric study showed that the reflex relaxation of the lower esophageal sphincter (LES) was incomplete or absent in 9 patients (56%). The upper esophageal sphincter (UES) was completely relaxed in all 16 patients. In 14 patients (88%), a normal peristaltic wave was present in the proximal esophagus, but absent below the anastomotic site. Simultaneous contractions were observed in 2 patients (12%). Seven (64%) of 11 patients who underwent 24 hour esophageal pH monitoring presented gastroesophageal reflux. CONCLUSION: Most of the patients after the repair of an EATEF developed motor dysfunction of the esophagus. Poor transmission of the peristaltic waves beyond the anastomotic site and abnormal reflex relaxation of the LES were present.
Barium ; Constriction, Pathologic ; Endoscopy ; Esophageal Atresia* ; Esophageal pH Monitoring ; Esophageal Sphincter, Lower ; Esophageal Sphincter, Upper ; Esophagus* ; Fistula ; Gastroesophageal Reflux ; Humans ; Manometry ; Reflex ; Reflex, Abnormal ; Relaxation ; Tracheoesophageal Fistula* ; Vomiting ; Weight Gain