Evaluation of esophagogastric junction relaxation by 4-second Integrated Relaxation Pressure in achalasia using High Resolution Manometry with water-perfused catheters

2014 ◽  
Vol 26 (11) ◽  
pp. 1551-1556 ◽  
Author(s):  
V. Ortiz ◽  
G. Poppele ◽  
N. Alonso ◽  
C. Castellano ◽  
V. Garrigues
Keyword(s):  
High Resolution ◽  
Esophagogastric Junction ◽  
High Resolution Manometry ◽  
Integrated Relaxation Pressure ◽  
Perfused Catheters

scholarly journals Elevated intrabolus pressure identifies obstructive processes when integrated relaxation pressure is normal on esophageal high-resolution manometry

2017 ◽  
Vol 313 (1) ◽  
pp. G73-G79 ◽  
Author(s):  
Farhan Quader ◽  
Chanakyaram Reddy ◽  
Amit Patel ◽  
C. Prakash Gyawali
Keyword(s):  
High Resolution ◽  
Clinical Utility ◽  
Esophagogastric Junction ◽  
Validation Cohort ◽  
Surrogate Marker ◽  
Healthy Controls ◽  
Clinical Value ◽  
High Resolution Manometry ◽  
Observational Cohort ◽  
Integrated Relaxation Pressure

Elevated integrated relaxation pressure (IRP) on esophageal high-resolution manometry (HRM) identifies obstructive processes at the esophagogastric junction (EGJ). Our aim was to determine whether intrabolus pressure (IBP) can identify structural EGJ processes when IRP is normal. In this observational cohort study, adult patients with dysphagia and undergoing HRM were evaluated for endoscopic evidence of structural EGJ processes (strictures, rings, hiatus hernia) in the setting of normal IRP. HRM metrics [IRP, distal contractile integral (DCI), distal latency (DL), IBP, and EGJ contractile integral (EGJ-CI)] were compared among 74 patients with structural EGJ findings (62.8 ± 1.6 yr, 67.6% women), 27 patients with normal EGD (52.9 ± 3.2 yr, 70.3% women), and 21 healthy controls (27.6 ± 0.6 yr, 52.4% women). Findings were validated in 85 consecutive symptomatic patients to address clinical utility. In the primary cohort, mean IBP (18.4 ± 0.9 mmHg) was higher with structural EGJ findings compared with dysphagia with normal EGD (13.5 ± 1.1 mmHg, P = 0.002) and healthy controls (10.9 ± 0.9 mmHg, P < 0.001). However, mean IRP, DCI, DL, and EGJ-CI were similar across groups ( P > 0.05 for each comparison). During multiple rapid swallows, IBP remained higher in the structural findings group compared with controls ( P = 0.02). Similar analysis of the prospective validation cohort confirmed IBP elevation in structural EGJ processes, but correlation with dysphagia could not be demonstrated. We conclude that elevated IBP predicts the presence of structural EGJ processes even when IRP is normal, but correlation with dysphagia is suboptimal. NEW & NOTEWORTHY Integrated relaxation pressure (IRP) above the upper limit of normal defines esophageal outflow obstruction using high-resolution manometry. In patients with normal IRP, elevated intrabolus pressure (IBP) can be a surrogate marker for a structural restrictive or obstructive process at the esophagogastric junction (EGJ). This has the potential to augment the clinical value of esophageal HRM by raising suspicion for a structural EGJ process when IBP is elevated.

scholarly journals Physiological and pathological roles of the accommodation response in lower esophageal sphincter relaxation during wet swallows

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kazumasa Muta ◽  
Eikichi Ihara ◽  
Shohei Hamada ◽  
Hiroko Ikeda ◽  
Masafumi Wada ◽  
...  
Keyword(s):  
Clinical Practice ◽  
High Resolution ◽  
Observational Study ◽  
Lower Esophageal Sphincter ◽  
Relaxation Function ◽  
Esophagogastric Junction ◽  
Prospective Observational Study ◽  
Outflow Obstruction ◽  
High Resolution Manometry ◽  
Esophageal Sphincter

AbstractThe preparatory accommodation response of lower esophageal sphincter (LES) before swallowing is one of the mechanisms involved in LES relaxation during wet swallows, however, the physiological and/or pathological roles of LES accommodation remain to be determined in humans. To address this problem, we conducted a prospective observational study of 38 patients with normal high-resolution manometry (HRM) and 23 patients with idiopathic esophagogastric junction outflow obstruction (EGJOO) to assess dry and wet swallows. The LES accommodation measurement was proposed for practical use in evaluating the LES accommodation response. Although swallow-induced LES relaxation was observed in both dry and wet swallows, LES accommodation (6.4, 3.1–11.1 mmHg) was only observed in wet swallows. The extent of LES accommodation was impaired in idiopathic EGJOO (0.6, − 0.6–6 mmHg), and the LES accommodation measurement of patients with idiopathic EGJOO (36.8, 29.5–44.3 mmHg) was significantly higher in comparison to those with normal HRM (23.8, 18–28.6 mmHg). Successful LES relaxation in wet swallowing can be achieved by LES accommodation in combination with swallow-induced LES relaxation. Impaired LES accommodation is characteristic of idiopathic EGJOO. In addition to the IRP value, the LES accommodation measurement may be useful for evaluating the LES relaxation function in clinical practice.

scholarly journals 3D-high resolution manometry of the esophagogastric junction

2011 ◽  
Vol 23 (11) ◽  
pp. e461-e469 ◽  
Author(s):  
M. A. Kwiatek ◽  
J. E. Pandolfino ◽  
P. J. Kahrilas
Keyword(s):  
High Resolution ◽  
Esophagogastric Junction ◽  
High Resolution Manometry

scholarly journals Novel 3D high-resolution manometry metrics for quantifying esophagogastric junction contractility

2017 ◽  
Vol 29 (8) ◽  
pp. e13054 ◽  
Author(s):  
Zhiyue Lin ◽  
Yinglian Xiao ◽  
Yuwen Li ◽  
John E. Pandolfino ◽  
Minhu Chen ◽  
...  
Keyword(s):  
High Resolution ◽  
Esophagogastric Junction ◽  
High Resolution Manometry

The Value of High-Resolution Manometry in Measurement of EGJ Competency and Manometric Outcomes of Antireflux Surgery

2021 ◽  
Vol 1 (3) ◽  
pp. 227-233
Author(s):  
Sumeet K. Mittal ◽  
Komeil Mirzaei Baboli
Keyword(s):  
High Resolution ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Antireflux Surgery ◽  
Esophagogastric Junction ◽  
Normal Values ◽  
Pressure Profile ◽  
Objective Measures ◽  
High Resolution Manometry ◽  
Integral Role

The esophagogastric junction (EGJ) barrier plays an integral role in the prevention of gastroesophageal reflux; however, not much attention has been paid to competency parameters, especially in the era of high-resolution manometry (HRM). HRM provides a unique spatiotemporal pressure profile and measurements of the EGJ. Herein, we discuss the evidence for objective measures of EGJ competency, which should guide the clinical management of gastroesophageal reflux disease. Additionally, we will briefly discuss expected normal values after antireflux surgery.

Sign in / Sign up

Export Citation Format

Share Document