Deglutition disorders in infancy are often associated with birth asphyxia or structural abnormalities in the hypopharynx, the trachea, or the esophagus. Manometry can be crucial for clarifying the dynamics of the swal...Deglutition disorders in infancy are often associated with birth asphyxia or structural abnormalities in the hypopharynx, the trachea, or the esophagus. Manometry can be crucial for clarifying the dynamics of the swallowing disorder in the infant with deglutition problems and without signs of these causes. An 8-week-old infant was referred because of suspicion of cricopharyngeal achalasia causing persistent swallowing problems and failure to thrive. Manometry results showed normal resting tone and relaxation but premature closure of the upper esophageal sphincter. The infant was treated with balloon dilatation of the upper esophageal sphincter and expectance. A maturation process of the swallowing sequence was noted over time and documented by repeated manometric procedures.展开更多
Background & Aims: Recent studies have shown the existence of several reflex connections between the aerodigestive and upper gastrointestinal tracts. Our aim was to study the effect of laryngeal stimulation on upp...Background & Aims: Recent studies have shown the existence of several reflex connections between the aerodigestive and upper gastrointestinal tracts. Our aim was to study the effect of laryngeal stimulation on upper esophageal sphincter(UES) pressure and to determine the reproducibility of this effect. Methods: We studied 14 young and 10 elderly healthy nonsmoker volunteers and 7 patients with UES dysphagia using a concurrent manometric and video endoscopic technique.Three levels of laryngeal air stimulation were studied: 6 mmHg/50 ms, 10 mm Hg/50 ms, and 6 mm Hg/2 s. Ten young subjects were studied twice. Results: For 6mm Hg/2s and 6mm Hg/50ms duration stimuli, the frequency of UES response to air stimulation as evidenced by mucosal deflection(response/deflection ratio) in the elderly volunteers was significantly lower compared with that of young subjects (P < 0.05). The response/deflection ratio of the 6mm Hg/2s stimulus was significantly higher than those induced by stimuli of shorter duration (P < 0.01). Poststimulation UES pressure was significantly higher than prestimulation pressure (P < 0.05) in both groups. The magnitude of the increase in poststimulation UES pressure in the elderly volunteers was similar to that of the young subjects. Findings were similar in repeated studies.Four of 7 dysphagic patients exhibited an abnormal response.Conclusions: Afferent signals originating from the larynx reproducibly induce contraction of the UES: the laryngo-UES contractile reflex. This reflex is elicited most reliably by 6mm Hg/2s air stimulation. Frequency elicitation of this reflex decreases significantly with age while the magnitude of change in UES pressure remains unchanged, indicating a deleterious effect of aging on the afferent arm of this reflex. This reflex is altered in some dysphagic patients.展开更多
Background and study aim: Capsule endoscopy, using the PillCam ESO and sending images at a rate of 4 frames per second (fps), has a high sensitivity and specificity in diagnosing gastroesophageal reflux disease (GERD)...Background and study aim: Capsule endoscopy, using the PillCam ESO and sending images at a rate of 4 frames per second (fps), has a high sensitivity and specificity in diagnosing gastroesophageal reflux disease (GERD) lesions. We tested a new device which produces images at a rate of 14 fps. The diagnostic performance and esophageal visualization of these two devices were compared. Patients and methods: 42 patients with GERD symptoms and eight patients with a history of Barrett’ s esophagus had an esophagogastroduodenoscopy (EGD).All patients underwent capsule endoscopy of the esophagus within 1 hour prior to EGD. The first 25 patients had a capsule endoscopy examination with the 4 fps device. The following 25 patients underwent capsule endoscopy under identical conditions but using the 14 fps device. The reader of the capsule endoscopy study was blinded to the EGD findings. A diagnosis of GERD or Barrett’ s esophagus was established with EGD. The findings at capsule endoscopy were compared with the EGD findings. We also examined how frequently the esophagus in its entirety was visualized by these two devices. Results: The 4 fps device diagnosed 16/19 cases of esophageal erosions or ulcers (sensitivity 84 % ) and 6/8 cases of Barrett’ s esophagus (sensitivity 75 % ). The 14 fps capsule diagnosed 16/16 cases of esophageal ulcers or erosions and 7/7 cases of Barrett’ s esophagus (sensitivity 100 % ). The total diagnostic miss rate in the 4 fps group was 5/27 (18 % ) whereas the diagnostic miss rate in the 14 fps group was 0/23 (0 % ) P < 0.02. The upper esophageal sphincter (UES) was clearly identified in 6/25 patients (24 % ) in the 4 fps group and in 20/25 patients (80% ) in the 14 fps group (P < 0.01). The entire esophagus was well visualized in 3/25 patients (12 % ) by the 4 fps device and in 19/25 (76 % ) by the 14 fps device (P < 0.01). The superiority of the 14 fps PillCam ESO capsule is consistent with the data obtained from fluoroscopic studies of swallowed PillCam capsules, showing that capsule speed may reach 20 cm/s. For the 14 fps PillCam thismeans one image transmitted per 3 cm segment at maximal capsule speed, therefore still allowing for full visualization of the entire esophagus. Conclusions: Capsule endoscopy using the 14 fps PillCam ESO showed a greater sensitivity than that of the 4 fps device for identifying GERD. The 14 fps PillCam ESO was statistically superior to the 4 fps device in visualizing the opening of the UES and the entirety of the esophagus.展开更多
文摘Deglutition disorders in infancy are often associated with birth asphyxia or structural abnormalities in the hypopharynx, the trachea, or the esophagus. Manometry can be crucial for clarifying the dynamics of the swallowing disorder in the infant with deglutition problems and without signs of these causes. An 8-week-old infant was referred because of suspicion of cricopharyngeal achalasia causing persistent swallowing problems and failure to thrive. Manometry results showed normal resting tone and relaxation but premature closure of the upper esophageal sphincter. The infant was treated with balloon dilatation of the upper esophageal sphincter and expectance. A maturation process of the swallowing sequence was noted over time and documented by repeated manometric procedures.
文摘Background & Aims: Recent studies have shown the existence of several reflex connections between the aerodigestive and upper gastrointestinal tracts. Our aim was to study the effect of laryngeal stimulation on upper esophageal sphincter(UES) pressure and to determine the reproducibility of this effect. Methods: We studied 14 young and 10 elderly healthy nonsmoker volunteers and 7 patients with UES dysphagia using a concurrent manometric and video endoscopic technique.Three levels of laryngeal air stimulation were studied: 6 mmHg/50 ms, 10 mm Hg/50 ms, and 6 mm Hg/2 s. Ten young subjects were studied twice. Results: For 6mm Hg/2s and 6mm Hg/50ms duration stimuli, the frequency of UES response to air stimulation as evidenced by mucosal deflection(response/deflection ratio) in the elderly volunteers was significantly lower compared with that of young subjects (P < 0.05). The response/deflection ratio of the 6mm Hg/2s stimulus was significantly higher than those induced by stimuli of shorter duration (P < 0.01). Poststimulation UES pressure was significantly higher than prestimulation pressure (P < 0.05) in both groups. The magnitude of the increase in poststimulation UES pressure in the elderly volunteers was similar to that of the young subjects. Findings were similar in repeated studies.Four of 7 dysphagic patients exhibited an abnormal response.Conclusions: Afferent signals originating from the larynx reproducibly induce contraction of the UES: the laryngo-UES contractile reflex. This reflex is elicited most reliably by 6mm Hg/2s air stimulation. Frequency elicitation of this reflex decreases significantly with age while the magnitude of change in UES pressure remains unchanged, indicating a deleterious effect of aging on the afferent arm of this reflex. This reflex is altered in some dysphagic patients.
文摘Background and study aim: Capsule endoscopy, using the PillCam ESO and sending images at a rate of 4 frames per second (fps), has a high sensitivity and specificity in diagnosing gastroesophageal reflux disease (GERD) lesions. We tested a new device which produces images at a rate of 14 fps. The diagnostic performance and esophageal visualization of these two devices were compared. Patients and methods: 42 patients with GERD symptoms and eight patients with a history of Barrett’ s esophagus had an esophagogastroduodenoscopy (EGD).All patients underwent capsule endoscopy of the esophagus within 1 hour prior to EGD. The first 25 patients had a capsule endoscopy examination with the 4 fps device. The following 25 patients underwent capsule endoscopy under identical conditions but using the 14 fps device. The reader of the capsule endoscopy study was blinded to the EGD findings. A diagnosis of GERD or Barrett’ s esophagus was established with EGD. The findings at capsule endoscopy were compared with the EGD findings. We also examined how frequently the esophagus in its entirety was visualized by these two devices. Results: The 4 fps device diagnosed 16/19 cases of esophageal erosions or ulcers (sensitivity 84 % ) and 6/8 cases of Barrett’ s esophagus (sensitivity 75 % ). The 14 fps capsule diagnosed 16/16 cases of esophageal ulcers or erosions and 7/7 cases of Barrett’ s esophagus (sensitivity 100 % ). The total diagnostic miss rate in the 4 fps group was 5/27 (18 % ) whereas the diagnostic miss rate in the 14 fps group was 0/23 (0 % ) P < 0.02. The upper esophageal sphincter (UES) was clearly identified in 6/25 patients (24 % ) in the 4 fps group and in 20/25 patients (80% ) in the 14 fps group (P < 0.01). The entire esophagus was well visualized in 3/25 patients (12 % ) by the 4 fps device and in 19/25 (76 % ) by the 14 fps device (P < 0.01). The superiority of the 14 fps PillCam ESO capsule is consistent with the data obtained from fluoroscopic studies of swallowed PillCam capsules, showing that capsule speed may reach 20 cm/s. For the 14 fps PillCam thismeans one image transmitted per 3 cm segment at maximal capsule speed, therefore still allowing for full visualization of the entire esophagus. Conclusions: Capsule endoscopy using the 14 fps PillCam ESO showed a greater sensitivity than that of the 4 fps device for identifying GERD. The 14 fps PillCam ESO was statistically superior to the 4 fps device in visualizing the opening of the UES and the entirety of the esophagus.
