| 1. |
- Olsson, Rolf, et al.
(författare)
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Simultaneous videoradiography and pharyngeal solid state manometry (videomanometry) in 25 nondysphagic volunteers
- 1995
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Ingår i: Dysphagia. - 1432-0460. ; 10:1, s. 36-41
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Tidskriftsartikel (refereegranskat)abstract
- Recent technological advances in manometry, including solid state transducers and computerized analysis, allows for reliable interpretation of intraluminal pharyngeal pressures. Simultaneous videoradiography (barium swallow) provides fluoroscopic control of the manometric sensors (videomanometry), thereby eliminating the uncertainty of sensor dislocation during laryngeal elevation. This is the first study describing normal manometric parameters in videomanometry during barium swallow. Seven manometric parameters and six videoradiographic parameters were analyzed. We included 25 nondysphagic volunteers with normal videoradiographic parameters in the study. The examination was performed in an upright physiologic position during 10-ml barium and dry swallows. Mean resting pressure in the upper esophageal sphincter was 89.6 +/- 32.6 (+/- 2 SD) mmHg. Mean residual pressure during relaxation of the upper esophageal sphincter was 7.2 +/- 8.0 (+/- 2 SD) mmHg during barium swallow and 3.8 +/- 6.2 (+/- 2 SD) mmHg during dry swallow. The mean duration of upper esophageal sphincter relaxation was 601 +/- 248 (+/- 2 SD) msec. The mean peristaltic contraction of the upper esophageal sphincter was 253.8 +/- 142.8 (+/- 2 SD) mmHg. Fourteen (56%) of the 25 had a measurable intrabolus pressure (mean 33.2 +/- 17.3 mmHg) at the level of the inferior pharyngeal constrictor. A specific finding was discovered when the epiglottis tilts down hitting the manometric sensor. This epiglottic tilt was identified in 7 subjects (28%) and caused pressures of around 600 mmHg. A standardized manometric technique is important in videomanometry, and normal values as described in this study are essential in clinical use.
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| 2. |
- Ekberg, Olle, et al.
(författare)
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Autonomic nerve dysfunction in patients with bolus-specific esophageal dysmotility
- 1995
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Ingår i: Dysphagia. - 1432-0460. ; 10:1, s. 44-48
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Tidskriftsartikel (refereegranskat)abstract
- The pathogenetic mechanisms causing esophageal dysmotility is not well understood. We examined 13 patients with solid bolus dysphagia in a radiologic barium study including the swallowing of a 14-mm tablet. In all 13 patients the tablet was caught in the proximal or midesophagus. In 8 patients, the entrapment was associated with symptoms (Group 1) whereas in 5 patients (Group 2), no symptoms were reported. All 13 patients together with a control group of 56 healthy, nondysphagic subjects were tested for autonomic nerve function. Autonomic nerve function tests included registration of electrocardiographic R-R interval variation during deep breathing test (E/I ratio), a test of parasympathetic, vagal, nerve function. The results showed that the E/I ratio was significantly lower in patients with symptoms of bolus-specific esophageal dysmotility (-2,19 [1.76]) (median [interquartile range]) compared with patients without symptoms (0.05 [2, 87], p = 0.0192) and controls (-0.25 [1.26], p = 0.0009). In conclusion, symptomatic bolus-specific esophageal dysmotility is associated with vagal nerve dysfunction.
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| 3. |
- Ekberg, Olle, et al.
(författare)
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Das pharyngoosophageale Segment
- 1995
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Ingår i: Radiologe. - 0033-832X. ; 35:10, s. 689-692
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Tidskriftsartikel (refereegranskat)abstract
- The pharyngoesophageal segment (PES) is a striated muscular structure separating the relatively wide pharynx from the narrow cervical esophagus. There is a substantial axial and longitudinal asymmetry within the PES, as well as basal resting pressure that is substantially influenced by a variety of stimuli as well as deglutition.
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| 4. |
- Olsson, Rolf, et al.
(författare)
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Solid-state computerized manometry improves diagnostic yield in pharyngeal dysphagia: simultaneous videoradiography and manometry in dysphagia patients with normal barium swallows
- 1995
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Ingår i: Abdominal Imaging. - 0942-8925. ; 20:3, s. 230-235
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Dynamic barium radiology with cine- or video recording has been the most frequently used technique for assessing patients with pharyngeal dysphagia. Although the diagnostic yield of the barium swallow has been high, many patients with pharyngeal dysphagia have normal dynamic barium radiology and remain a diagnostic dilemma. Could manometry add important diagnostic information in these patients? MATERIAL AND METHODS: We examined 19 patients (12 men and 7 women, mean age 47 years, range 19-69 years) with pharyngeal dysphagia but a normal barium swallow with simultaneous videoradiography and pharyngeal manometry and compared their manometry to that found in 24 normal volunteers (11 men and 13 women, mean age 37 years, range 23-59 years). RESULTS: Comparing mean values, the patient group showed statistically significant differences from the control group for eight of 10 manometric parameters. Fourteen of 19 patients showed at least one (five patients) and in most cases multiple (nine patients) manometric abnormalities (values exceeding normal mean by +/- 2SD) which might have contributed to their dysphagia: five patients with high upper esophageal sphincter (UES) resting pressures, five with high UES residual pressures, three with weak pharyngeal contractions, three with pharyngeal "spasms," seven with prolonged contraction/relaxation times, five with reduced compliance, and seven with UES/P incoordination. CONCLUSIONS: Solid-state computerized manometry is a useful adjunct to videoradiography and can provide potentially important additional information in the diagnosis of dysphagia patients.
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| 5. |
- Olsson, Rolf, et al.
(författare)
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Videomanometry of the pharynx in dysphagic patients with a posterior cricopharyngeal indentation
- 1995
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Ingår i: Academic Radiology. - 1878-4046. ; 2:7, s. 597-601
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Tidskriftsartikel (refereegranskat)abstract
- RATIONALE AND OBJECTIVES: Patients with a posterior indentation in the pharyngoesophageal segment (PES) are generally considered to have an abnormality of the cricopharyngeal muscle (CPM). In this study we determined the actual width of the PES and the pressure circumstances during swallowing within the pharynx and PES in such patients. METHODS: Simultaneous videofluoroscopy and solid state manometry, radiologic examination of the pharynx, PES, and cervical esophagus were performed in 16 dysphagic patients with a cricopharyngeal (CP) bar. In eight patients the indentation was 25-50%, and in eight it was more than 50% of the adjacent gullet. Sixteen dysphagic patients without a CP bar were used as control subjects. In each patient swallows of 10-ml barium bolus were recorded. RESULTS: Patients with CP bars had a significantly wider PES above (p = .0005) and below (p = .02) the CPM, whereas the diameter at the level of the CPM was smaller only in the patients with more than 50% indentation compared with the patients without a CP bar. The contraction pressure above the CP bar (i.e., at the level of the inferior pharyngeal constrictor) was significantly (p = .002) weaker in patients with a CP bar (131 +/- 16 mm Hg) than in those without a CP bar (222 +/- 20 mm Hg). CONCLUSION: Our findings in patients with a posterior CP bar suggest that the major abnormality is weak constrictors with outpouching of the gullet above and below. Only in patients with more than 50% indentation was there a slight narrowing at the level of the CP bar. The CPM showed no manometric abnormalities in terms of resting pressure, relaxation, and contraction pressure. Therefore, the CPM is likely to relax and distend normally during swallowing in patients with a CP bar.
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