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A Novel Test of Esophageal Function during Meal Consumption

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Wilson, Jason MD; Mainie, I. MRCP; Hila, A. MD; Tutuian, R. MD; Agrawal, A. MD; Castell, D. MD

American Journal of Gastroenterology: September 2006 - Volume 101 - Issue - p S67–S68
Abstracts: ESOPHAGUS
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Digestive Disease Center, Medical University of South Carolina, Charleston, SC.

Purpose: Standard esophageal manometric testing evaluates swallowing in the supine position using small boluses with a recovery period imposed between swallows. Prior manometric tests of more physiologic unrestricted eating have had limited practical application due to highly variable outcomes. The purpose of this study is to apply multichannel intraluminal impedance and manometry (MII-EM) to test esophageal function during unrestricted upright meal consumption, and to determine results with limited variability in a normal healthy population.

Methods: Ten healthy volunteers with normal esophageal impedance and manometry by published criteria underwent MII-EM testing using a combined 5-channel catheter. After transnasal placement of the catheter, each subject sat upright and consumed a meal that consisted of two pieces of toasted bread and two ounces of Gatorade. During the meal the catheter continuously recorded impedance and manometry signals at 50Hz. There were no restrictions placed on eating time, and all subjects completed the meal without difficulty.

Results: All data assessed by the MII-EM meal test were normally distributed. Traditional results for manometry (e.g. contraction amplitude, distal velocity) and impedance (e.g. complete bolus transit) assessed by the meal test were highly variable. Meal test impedance results with limited variability included the meal duration, number of swallows, and the percent bolus presence time (%BPT) at 10 and 5 cm above the lower esophageal sphincter (Table 1). Manometric results with limited variability included the number of peristaltic sequences, mean time between sequences, and the distal esophageal amplitudes (Table 2).

Table 1

Table 1

Table 2

Table 2

Conclusions: MII-EM can be used to collect data with minimal variability in healthy subjects during unrestricted upright meal consumption. These methods may be used to identify abnormal motility patterns during physiologic swallowing.

© The American College of Gastroenterology 2006. All Rights Reserved.