Utilizing Intraluminal Pressure Gradients to Predict Esophageal Clearance: A Validation Study

Pandolfino, John E.; Ghosh, Sudip K.; Lodhia, Nilesh; Kahrilas, Peter J.
August 2008
American Journal of Gastroenterology;Aug2008, Vol. 103 Issue 8, p1898
Academic Journal
BACKGROUND: Esophageal bolus clearance requires a preferential esophagogastric pressure gradient sustained for a sufficient period. We aimed to validate a high-resolution manometry (HRM) paradigm for predicting bolus clearance. METHODS: Twenty volunteers and 30 patients were studied with HRM during barium swallows with concurrent fluoroscopy. Simultaneous bolus domain pressure and esophagogastric junction (EGJ) obstruction pressure were plotted and flow permissive time was tallied during which the bolus domain pressure exceeded the EGJ obstruction pressure. Distal peristaltic integrity was assessed at incrementally increasing pressure isobaric contour thresholds from 15–40 mmHg. ROC analysis was performed to assess the sensitivity and specificity of cutoff values for flow permissive time and peristaltic amplitude for predicting incomplete clearance as verified fluoroscopically. RESULTS: Flow permissive time ≤2.5 s had a sensitivity of 86% and specificity of 92% for predicting incomplete clearance. In contrast, a 30-mmHg peristaltic amplitude had a sensitivity of only 48% and specificity of 88%. Incomplete clearance was variably attributable to functional EGJ obstruction, hiatus hernia, or impaired peristalsis. CONCLUSIONS: A detailed analysis of intraluminal pressure gradients in the distal esophagus and across the EGJ in the postdeglutitive period predicts esophageal bolus clearance with far greater accuracy than any threshold value of peristaltic amplitude.


Related Articles

  • Esophageal 24-h pH Monitoring: Is Prior Manometry Necessary for Correct Positioning of the Electrode? Klauser, Andreas G.; Schindlbeck, Norbert E.; Müller-Lissner, Stefan A. // American Journal of Gastroenterology;Nov1990, Vol. 85 Issue 11, p1463 

    In 24-h esophageal pH monitoring, the electrode is usually positioned 5 cm above the manometrically localized esophagogastric junction. In order to replace esophageal manometry for this purpose, we tested whether the esophagogastric junction can be identified correctly by fluoroscopy or the...

  • Relationship Between Pressure Wave Amplitude and Esophageal Bolus Clearance Assessed by Combined Manometry and Multichannel Intraluminal Impedance Measurement. Nguyen, Nam Q.; Tippett, Marcus; Smout, Andre J.P.M.; Holloway, Richard H. // American Journal of Gastroenterology;Nov2006, Vol. 101 Issue 11, p2476 

    OBJECTIVES: Esophageal wave amplitude is an important determinant of esophageal clearance. A threshold of 30 mmHg is widely accepted as the threshold for effective clearance in the distal esophagus. However, the precise relationship between wave amplitude and clearance has received relatively...

  • High-resolution and conventional manometry in the assessment of the lower esophageal sphincter length. Herbella, Fernando A. M.; Vicentine, Fernando P. P.; Del Grande, Jose C. // Journal of Gastrointestinal Surgery;Sep2010, Vol. 14 Issue 9, p1466 

    A letter to the editor is presented in response to the article "The Value of High-Resolution Manometry in the Assessment of the Resting Characteristics of the Lower Esophageal Sphincter," by S. Ayazi and colleagues in a previous issue.

  • Re: High-Resolution Manometry and Lower Esophageal Sphincter Length. Ayazi, Shahin; Hagen, Jeffery; Zehetner, Joerg; DeMeester, Steven; Lipham, John; DeMeester, Tom // Journal of Gastrointestinal Surgery;Sep2010, Vol. 14 Issue 9, p1468 

    A response by Shahin Ayazi and colleagues to a letter to the editor about their article "The Value of High-Resolution Manometry in the Assessment of the Resting Characteristics of the Lower Esophageal Sphincter" in a 2010 issue is presented.

  • Marked asymmetry of LES: Important element of LES barrier in subsets of patients with reflux... Sluss, K.F.; Donahue, P.E. // American Surgeon;Jul1995, Vol. 61 Issue 7, p573 

    Determines whether computerized axial manometry (CAM) can explain the function of the lower esophageal sphincter (LES) in health and disease. Comparison of CAM data of gastroesophageal reflux disease (GERD) patients with normal study volunteers; Basis of reflux diagnosis on endoscopic...

  • Absence of an Upper Esophageal Sphincter Response to Acid Reflux. Vakil, N. B.; Kahrilas, P. J.; Dodds, W. J.; Vanagunas, A. // American Journal of Gastroenterology;Jun1989, Vol. 84 Issue 6, p606 

    Manometric studies of the upper esophageal sphincter (UES) were done on 17 volunteer subjects and 16 patients with endoscopically evident esophagitis. Subjects entered one or both of two protocols designed to assess the effect of esophageal acid exposure on UES pressure. In protocol 1,...

  • Balloon Sensors for the Manometric Recording of the Pharyngoesophageal Tract: An Experimental Study. Mattioli, Sandro; Lugaresi, Marialuisa; Zannoli, Romano; Brusori, Stefano; d’Ovidio, Franco // Dysphagia (0179051X);Oct2003, Vol. 18 Issue 4, p249 

    The goal of our study was to investigate manometric balloon sensors of original conception in order to overcome the limitations of perfused and solid-state sensors in the assessment of the pharyngoesophageal motility abnormalities. A standard perfused probe for esophageal manometry was modified...

  • Pharyngoesophageal Manometry with an Original Balloon Sensor Probe for the Study of Oropharyngeal Dysphagia. Mattioli, Sandro; Lugaresi, Marialuisa; Zannoli, Romano; Brusori, Stefano; d’Ovidio, Franco; Braccaioli, Laura // Dysphagia (0179051X);Oct2003, Vol. 18 Issue 4, p242 

    The goal of our study was to verify the clinical applicability of an original balloon sensor probe for the manofluorographic study of oropharyngeal dysphagia. A prototype apparatus for manofluorography was developed and a standard perfused probe for esophageal manometry was modified by applying...

  • Do we really understand the role of the oesophagogastric junction in disease? McMahon, Barry P.; Jobe, Blair A.; Pandolfino, John E.; Gregersen, Hans; Shimatani, Tomohiko // World Journal of Gastroenterology;1/14/2009, Vol. 15 Issue 2, p144 

    The role of the oesophago-gastric junction (OGJ) in gastro-oesophageal reflux disease is still not completely understood, and there is no clinically used method to assess the OGJ function in patients. Only indirect methods such as pH studies are carried out. The OGJ acts a valve controlling the...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics