超声内镜确定胰腺随年龄增长的变化状况:一项前瞻性研究

Background: EUS is an important modality for the diagnosis of pancreatic disea se. An understanding of normal pancreatic ductal and parenchymal variation in as ymptomatic individuals is essential to improve EUS accuracy. The primary aim of this study was to determine age-related pancreatic parenchymal and ductular cha nges identifiable on EUS in individuals with no history or symptoms of pancreati cobiliary disease. Secondary aims were to define demographic and clinical factor s associated with identifiable pancreatic parenchymal and ductular changes,and t o determine the main pancreatic-duct diameter and pancreatic-gland width accor ding to age. Methods: Patients referred for either upper endoscopy or EUS for an indication unrelated to pancreaticobiliary disease were prospectively enrolled. Patients were stratified by age (< 40, 40-60, >60 years). Each patient was ass essed for the presence of EUS findings for chronic pancreatitis. Logistic regres sion was used to identify factors associated with an abnormality. Results: A tot al of 120 patients(63 men, 57 women; median age, 52 years, interquartile range[I QR] 40-61 yea- rs) were prospectively evaluated. At least one parenchymal and/or ductular abn ormality was identified in 28%of the patients, with a trend of increasing abnor mality with age:< 40 years (23%), 40 to 60 years (25%), and >60 years (39%);p = 0.13. No patient had more than 3 abnormal EUS features.Hyperechoic stranding (n = 22) was the most common finding in all age groups. The odds for any abnorma lity in men (relative to women) was significantly higher (OR 2.9: 95%CI[1.2, 6. 8],p = 0.01), with 38%of men and 18%of women having an abnormality. Smoking, l ow alcohol intake, body mass index,and endoscopic finding were not significantly associated with an abnormal EUS. The overall median pancreatic-gland width and main pancreatic duct diameter were 15 mm (IQR 6-25 mm) and 1.7 mm(IQR 0.9-4.3 mm), respectively. Conclusions:The frequency of EUS abnormalities in patients w ithout clinical evidence of chronic pancreatitis increases with age, particularl y after 60 years of age. The threshold number of EUS criteria for the diagnosis of chronic pancreatitis is variable. However, the typically used standard of 3 o r more criteria appears appropriate.A higher number of threshold criteria may be needed in males and to a lesser extent in patients over 40 years of age,which s hould be related to clinical history and other structural or functional studies. Ductal or parenchymal calculi, ductal narrowing,ductal dilatation, or more than 3 abnormalities appear to be more specific features for the EUS diagnosis of ch ronic pancreatitis at any age.

EUS引导下的Trucut针吸活检:确定自身免疫性胰腺炎是否为梗阻性黄疽的病因

Background: The diagnosis of autoimmune pancreatitis can be difficult and ofte n requires a larger specimen than can be provided by FNA alone to determine if t he tissue sample obtained with EUS trucut biopsy (TCB) is sufficient to allow ad equate histologic review to establish the diagnosis of autoimmune pancreatitis. Methods: EUS TCB was performed in patients presenting with obstructive jaundice who were suspected of having autoimmune pancreatitis based on their clinical, la boratory and imaging studies. The charts were retrospectively reviewed to determ ine the feasibility of TCB. Results: Between August 2002 and June 2004, 3 patien ts with obstructive jaundice and suspected autoimmune pancreatitis (AIP) underwe nt EUS TCB. In each case, a diagnosis of pancreatic cancer also was considered, and surgical resection was the planned therapy before the patient underwent EUS TCB. Histologic review of the TCB specimens established the diagnosis of AIP in two patients and identified nonspecific changes of chronic pancreatitis in the t hird patient. EUS-guided FNA was performed in two of the 3 patients and failed to establish the diagnosis in either patient. Other than mild transient abdomina l pain (n = 1), no complications were identified. Conclusions: This preliminary study suggests that EUS TCB can safely establish the diagnosis of AIP. Doing so helps guide management and may help to avoid unnecessary surgery. Prosp- ective studies are needed to verify these findings and to more clearly define the role of EUS TCB in these patients.

遗传和环境因素对症状性胆石症的影响:一项瑞典43141例双胞胎的研究

The contribution of hereditary and environmental factors to the pathogenesis of symptomatic gallstone disease is still unclear. We estimated the relative importance of genetic and environmental factors by analyzing a large population of twins. For this purpose, the Swedish Twin Registry was linked with the Swedish inpatient-discharge and causes of death registries for symptomatic gallstone disease and gallstone surgery-related diagnoses in 43,141 twin pairs born between 1900 and 1958. Concordance rates, correlations, and odds ratios were calculated for males, females, monozygotic, and dizygotic twins, respectively, as well as for twin pairs of opposite sex. Structural equation modeling techniques were used to estimate the contributions of genetic effects aswell as shared and non-shared environmental factors to the development of symptomatic gallstone disease. We found that concordances and correlations were higher in monozygotic compared with dizygotic twins, both for males and females. Of note, there were no significant sex differences in heritability. In the full model, genetic effects accounted for 25%(95%CI, 9%-40%), shared environmental effects for 13%(95%CI, 1%-25%), and unique environmental effects for 62%(95%CI, 56%-68%) of the phenotypic variance among twins. In conclusion, our results show heritability to be a major susceptibility factor for symptomatic gallstone disease, consistent with results from previous, much smaller studies.

吗替麦考酚酯在熊脱氧胆酸不敏感的原发性胆汁性肝硬化患者中的治疗作用

Background&Aims: Despite evidence for therapeutic efficacy with ursodeoxycholic acid (UDCA) in primary biliary cirrhosis (PBC), only 30-50%of patients achieve complete biochemical remission within 1 year of therapy. Mycophenolate mofetil (MMF) is an immunosuppressive medication that inhibits T and B lymphocyte proliferation. The aim of this investigation was to determine the safety and estimated efficacy of MMF in patients with PBC. Methods: Twenty-five patients with incomplete responses to UDCA (defined as persistent elevation of serum alkaline phosphatase ≥2 times the upper limit of normal) received MMF 1 g daily to a maximum of 3 g daily with UDCA (13-15 mg/kg per day) for 1 year. Liver biochemistries were determined at 3-month intervals with Mayo Risk Score calculated at baseline and end of therapy. Results: Nineteen (76%) patients completed 1 year of therapy. Despite improvements in serum alkaline phosphatase (920 ±308 vs. 709 ±242 IU/L, P = 0.001) and AST (65 ±31 vs. 51 ±19 IU/L, P = 0.007) levels, these findings were clinically insignificant. Exploratory analysis revealed a strong correlation between advanced PBC defined by higher Mayo Risk Score and reduction in serum alkaline phosphatase levels (r = -0.74, P = 0.006). Six patients (24%) did not complete therapy; adverse drug events were responsible for study withdrawal in 3 individuals. Adverse reactions that resolved spontaneously or by dose reduction occurred in 13 patients. Conclusions: MMF is not associated with important clinical benefits in PBC based on the results of this pilot investigation.

幽门螺杆菌根除治疗后反流性食管炎与食管裂孔疝程度有关

Background: Several studies have shown that reflux esophagitis (RE) occurs after eradication of Helicobacter pylori. However, endoscopic findings do not allow prediction of the development of RE after successful treatment. In this study, we evaluated the relationship between the prevalence of RE after eradication therapy and the degree of hiatal hernia. Methods: The study comprised 148 patients who had undergone H. pylori eradication therapy over the past 5 years. The degree of RE and hiatal hernia was evaluated based on endoscopic findings. Hiatal hernia was graded according to Hill’s gastroesophageal flap valve (GEFV; grades I-IV) classification. RE after eradication therapy was graded according to the Los Angeles classification system. H. pylori infection was confirmed in all patients by culture, urease test and histological examination of antral and fundic biopsy specimens. Results: Among 148 patients, there were 122 patients (82.4%) with successful and 26 (17.6%) with failed eradication therapy. RE was diagnosed in 25 (20.5%) out of 122 patients with successful therapy but only in 1 (3.8%) out of 26 patients with failed therapy (P <0.05). After successful eradication, 25 patients had mild RE (12 with grade A, 13 with grade B). Among patients of the successful eradication group (n = 122), RE was diagnosed in 2 (5.3%) out of 38 patients without hiatal hernia and in 23 (27.4%) out of 84 patients with hiatal hernia (P = 0.0051). Furthermore, RE was diagnosed in 2 (5.3%) out of 38 patients with GEFV grade I, 13 (24.1%) out of 54 with grade II, 7 (30.4%) among 23 with grade III, and 3 (42.9%) out of 7 patients with grade IV. The pH level of gastric juice after eradication therapy was lower in the group with successful eradication than in the group with failed therapy regardless of the incidence and degree of RE. Conclusions: There is a high incidence of RE after successful H. pylori eradication therapy. This incidence of RE was closely associated with the presence and degree of hiatal hernia and with the decrease in gastric juice pH. These findings suggest that the presence of hiatal hernia together with increase in gastric acidity are important determinant factors for the development of RE after successful H. pylori eradication therapy.

准备接受肝移植的患者中胃窦血管扩张的发病率及自然病史

Goals: To describe the prevalence and natural history of gastric antral vascular ectasia (GAVE) in patients with end-stage liver disease undergoing orthotopic liver transplantation (OLT). Background: GAVE is a well-recognized cause of gastrointestinal hemorrhage. Although 30%of patients with GAVE have liver disease, the prevalence of GAVE in patients with cirrhosis is not known. Study: We reviewed clinical records of patients who underwent OLT at our institution from February 1, 1998 to June 2003. Demographic and clinical details were recorded with attention to findings during upper endoscopy before and after OLT. Results: A total of 597 patients underwent OLT, and 345 were evaluated preoperatively with esophagogastroduodenoscopy (EGD). Eight (2.3%) were found to have GAVE before OLT. Three of these eight underwent EGD after OLT, and GAVE was absent in all three. None of the patients with GAVE experienced gastrointestinal bleeding postoperatively. Conclusions: GAVE was present in nearly 1 in 40 patients with end-stage liver disease who underwent EGD before OLT at our institution and appears to resolve after transplant. These findings are consistent with a previous report documenting resolution of GAVE after OLT.

炎症性肠病复发期检测粪便病原体的诊断学效益

Goals: We sought to determine the yield of stool analysis for bacterial culture, ova and parasites, and Clostridium difficile toxin in suspected relapses of inflammatory bowel disease (IBD). Background: The diagnostic yield of such stool studies has not been examined recently in theUnited States. Study: The medical records of consecutive IBD patients who underwent stool testing for relapses at our institution between July 1, 2000, and November 25, 2001, were abstracted for demographics, stool test results, recent antibiotic exposure,and hospitalization. Results: Fifty four patients were evaluated during 62 relapses with 99 stool samples. Twelve stool tests were positive. C. difficile accounted for the majority of positive tests (10/12). Of these, 9 (90%) were associated with antibiotic use in the prior month versus 10 (22%) in the C. difficile negative group (P < 0.001). Hospitalization, prednisone use, or sulfasalazine use did not differ significantly with C. difficile status. Eight C. difficile positive patients improved clinically with targeted antibiotic therapy. Two bacterial cultures (4%) were positive for Campylobacter jejuni and Plesiomonas shigelloides. Conclusion: Stool studies yielded a pathogen, mainly C. difficile, in 20%of the relapsing IBD patients. Antibiotic use was significantly associated with a positive C. difficile toxin. Toxinpositive patients improved clinically with targeted antibiotics.

临床表现和人格因素作为功能性消化不良患者的疗效预测指标:一项随机、双盲、安慰剂对照的交叉试验

The role of psychological factors or symptom pattern for the response to treatment in patients with unexplained (functional)dyspepsia is unknown. We hypothesized that patients with reflux-and ulcerlike symptoms would be more likely to respond to acid-lowering therapy, while psychological disturbances would be associated with a less favorable response to treatment. Seventy-eight patients with a diagnosis of functional dyspepsia were recruited and 75 completed the trial. Patients were treated for 4 weeks in a double-blind, placebo-controlled crossover trial starting in random order with either active drug(ranitidine, 150 mg b.d.) or placebo. Every 7 days, medication was switched from active drug to placebo, or vice versa. At entry, patient characteristics were assessed utilizing a semistructured standardized interview and standardized questionnaires,and weekly intensity of symptoms was assessed utilizing a visual analogue scale. Patients with a greater reduction of the symptom score during active treatment and an overall reduction of the global symptom score by more than 50% at the end of the study period were categorized as responders. Logistic regression analysis was utilized to assess the influence of symptom type and presence of psychological disturbances on the treatment response. During treatment the symptom score decreased significantly, from 32.1 ± 1.44 (SD) to 21.3 ± 1.9 at the end of the trial (P < 0.001). Twenty of 75 were responders.High scores for somatization (OR, 3.6; 95% Cl,1.2-11.4), anxiety (OR, 3.3; 95% Cl, 0.9-11.8), and reflux-like symptoms (OR, 5.3; 95% Cl, 1.7-16.7) were associated with response to treatment, while dysmotility-like symptoms were associated with an unfavorable response (OR, 0.3; 95% Cl,0.1-0.9). Symptom pattern and psychological disturbances are independent predictors of treatment response. Patients with reflux-like symptoms and greater psychological disturbances are more likely to respond to an acid-lowering compound.

美国三级转诊中心的肝炎构成

Background/Goals: There are limited data regarding the frequency and proporti onality of drug- induced hepatotoxicity in the United States. We sought to dete rmine the scope of nonfulminant drug- induced hepatitis as seen in a community - based hepatology referral service. Study: From a population of 4,039 outpatie nts referred for evaluation of acute (n = 96) and chronic (n = 3,943) liver dise ase over a 10- year period, we reviewed the records of those patients diagnosed with acute bona fide drug- induced hepatitis. Results: Thirty- two patients p resented with self- limited acute drug- induced hepatitis, representing 0.8% of all hepatology patients and 33% of those patients presenting with acute li ver injury. Antibiotics (amoxicillin/clavulanic acid, minocycline, nitrofurantoi n, an investigational ketolide antibiotic, trimethoprim- sulfamethoxazole, and trovafloxacin) were the class of drugs most frequently implicated (14 of 32; 44 % ), while amiodarone was the single agent most commonly associated with liver injury (7 of 32; 22% ). The mean age of affected patients was 52.2 years, and w e found a male predominance (18 of 32; 56% ). The mean time to biochemical reso lution after discontinuation of the offending agent was 14.1 weeks. Conclusions: Drug- induced hepatitis is an uncommon entity in clinical hepatology but does represent a significant proportion of acute self- limited liver disease in the United States. Antibiotics and amiodarone were the most common drug culprits in our population. Time to resolution following the discontinuation of the offendin g agent may be protracted. Prospective studies are needed to further assess the burden of drug- induced liver injury.

肾功能不全可能是准备接受肝移植的患者发生慢性贫血的部分原因

In patients with cirrhosis, anemia is common and is likely to be multifactorial, including decreased erythrocyte production,sequestration due to hypersplenism, hemolysis, and increased blood loss from gastrointestinal bleeding. Renal dysfunction is also common in liver disease and this may also cause anemia.However, an association between anemia and renal dysfunction has not been reported in patients with cirrhosis. Our objective was to determine whether anemia in cirrhotic patients is independently related to renal dysfunction. We conducted a retrospective chart review of patients in our institution listed for liver transplantation. We collected simultaneous data on age,hemoglobin, creatinine, albumin, liver enzymes, prothrombin time, and bilirubin. We excluded patients who were hospitalized or deceased to avoid confounding variables. Two hundred eighty-six (female n = 130) patients with a mean age of 52.8± 9.7(range,18-73) years were studied. Renal dysfunction(creatinine >1.2 mg/dL) was present in 55(19% ) patients, andanemia (hemoglobin<12 g/dL)was seen in 115 (40% ) patients.Anemia was more common in patients with renal dysfunction(64 versus 34% ;P< 0.001) compared to those with normal renal function. Creatinine, prothrombin time, and bilirubin showed an inverse relationship (all P s < 0.001) with hemoglobin, and albumin showed a positive correlation with hemoglobin (P < 0.001). Multivariate analysis showed that creatinine (OR, 2.4;95% CI, 1.05-5.3; P =0.038), prothrombin time (P=0.026),bilirubin (P=0.035), and albumin(P=0.001) were independent predictors of anemia. Renal dysfunction is an important cause of anemia in patients with cirrhosis. The role of erythropoietin in the management of anemia in patients with cirrhosis and renal dysfunction should be explored in prospective studies.

复发性移行细胞胆囊癌转移至胃肠道的超声内镜影像表现

Background: Recurrent transitional cell bladder cancer (TCBC) can metastasize to the GI tract albeit uncommonly. This is the first report of the EUS appearan ce of metastatic TCBC to the GI tract. In addition to describing the EUS feature s of recurrent metastatic TCBC, this study determined the number of patients ref erred for evaluation of a primary GI luminal cancer in which EUS instead establi shed the diagnosis of metastatic recurrent TCBC. Methods: Patients referred from July 2000 through April 2004 for EUS evaluation of a suspected primary GI lumin al cancer were retrospectively reviewed. For patients with an established diagno sis of recurrent metastatic TCBC, EUS images were retrospectively reviewed to id entify characteristic features. Results: Of 2216 patients undergoing EUS to eval uate a suspected primary GI luminal cancer, 3 men (0.14% : 95% confidence int erval [0.02% , 0.29% ]) (mean age 67 years, range 54- 74 years) were found in stead to have recurrent metastatic TCBC involving the duodenum (n = 1) or rectum (n = 2). The patients presented a mean of 32 months after diagnosis of the prim ary TCBC with change in bowel habit (n = 1) and symptoms of bowel obstruction (n = 2). In each patient, initial endoscopy revealed circumferential luminal steno sis and mucosal erythema, but mucosal biopsy specimens revealed normal tissue. E US demonstrated hypoechoic, symmetric, circumferential wall thickening, loss of deep wall layers, and pseudopodia- like extensions into the peri- intestinal t issues. In the two patients with rectal involvement, no evidence of direct infil tration from the bladder bed was seen. EUS- guided FNA was diagnostic of metast atic TCBC in all patients. Conclusions: Although most cases of hypoechoic bowel - wall thickening and stenosis are from primary GI neoplasia, recurrent TCBC sh ould be considered in patients with a history of this tumor. Correct diagnosis i s important, because this allows selection of appropriate therapeutic interventi ons. Although firm EUS criteria for TCBC cannot be established based on findings in 3 patients, certain features may prove useful. EUS- guided FNA can confirm the diagnosis.

与肠功能失调相关的肛门失禁亚型:临床、生理及社会心理方面的特征

BACKGROUND: We hypothesized that functional anal incontinence with no structur al explanation comprises distinct pathophysiologic subgroups that could be ident ified on the basis of the predominant presenting bowel pattern. METHODS: Consecu tive patients (n = 80) were prospectively grouped by bowel symptoms as 1) incont inence only, 2) incontinence +constipation, 3) incontinence +diarrhea, and 4) incontinence +alternating bowel symptoms. The Hopkins Bowel Symptom Questionnai re, the Symptom Checklist 90-R, and anorectal manometry were completed. RESULTS : Significant group differences were found between subcategories of incontinent patients on the basis of symptoms. Abdominal pain was more frequent in patients with altered bowel patterns. Patients with alternating symptoms reported the hig hest prevalence of abdominal pain, rectal pain, and bloating. Basal anal pressur es were significantly higher in alternating patients (P = 0.03). Contractile pre ssures in the distal anal canal were diminished in the incontinent only and dia rrhea groups (P = 0.004). Constipated patients with incontinence exhibited eleva ted thresholds for the urge to defecate (P = 0.027). Dyssynergia was significant ly more frequent in patients with incontinence and constipation or alternating b owel patterns. CONCLUSIONS: Distinct patterns of pelvic floor dysfunction were i dentified in patient subgroups with anal incontinence, based on the presence or absence of altered bowel patterns. Physiologic assessments suggested different p athophysiologic mechanisms among the subgroups. The evaluation of patients with fecal incontinence should consider altered bowel function.

继发于肝内瘤组织浸润的暴发性肝功能衰竭

Two patients with previously normal liver function, who presented with fulminant hepatic failure (FHF) of unknown etiology despite an extensive evaluation, are described. No etiology for FHF was apparent with initial evaluation. One patient was found to have nearly complete replacement of hepatic parenchyma by metastasis from an occult small cell lung carcinoma identified postmortem. The other patient had lymphomatous in filtration of the liver detected by a liver biopsy. Imaging studies were performed in the patients and did not reveal any evidence of neoplastic infiltration of the liver. Neoplastic involvement of liver should be considered in the differential diagnosis of FHF of unknown etiology. The imaging studies in this setting can be misleading.

慢性胃食管反流病(GERD)高危患者Barrett食管的发病率

Background: The reported frequency of Barrett’s esophagus(BE) in patients wit h reflux symptoms varies from 5%to 15%.The exact frequency of long-segment BE (LSBE) (>3 cm) and short-segment BE (SSBE) (< 3 cm) in patients with chronic s ymptoms of GERD is uncertain. The aim of this study was to determine the frequen cy of LSBE and SSBE in consecutive patients presenting for a first endoscopic ev aluationwith GERD as the indication. Methods: Consecutive patients presenting to the endoscopy unit of a Veterans Affairs Medical Center for a first upper endos copy with the indication of GERD were prospectively evaluated. Demographic infor mation (gender,race, age), data on tobacco use and family history of esophageal disease, and body mass index (BMI) were recorded for all patients. Before endosc opy, all patients completed a validated GERD questionnaire. The diagnosis of BE was based on the presence of columnar-appearing mucosa in the distal esophagus, with confirmation by demonstration of intestinal metaplasia in biopsy specimens . All patients with erosive esophagitis on the initial endoscopy underwent a sec ond endoscopy to document healing and to rule-out underlying BE.Patients with a history of BE, alarm symptoms (dysphagia,weight loss, anemia, evidence of GI bl eeding), or prior endoscopy were excluded. Results: A total of 378 consecutive p atients with GERD (94%men, 86%white; median age 56 years, range 27-93 years) were evaluated. A diagnosis of BE was made in 50 patients (13.2%). The median l ength of Barrett’s esophagus (BE) was 1.0 cm (range 0.5-15.0 cm). Of the patie nts with BE, 64%had short-segment BE (SSBE) (overall SSBE frequency 8.5%). Th e overall frequency of long-segment BE (LSBE) was 4.8%. A hiatal hernia was de tected in 62%of the pati- entswith BE. Of the 50 patientswith BE (median age 62 years, range 29-81 year s), 47 (94%) were men and 98%were white. Eighteen patients (36%) were using t obacco at the time of endoscopy; 23 (46%) were former users. The median body ma ss index (BMI) of patients with BE was 27.3 (overweight).There were no significa nt differences between patients with LSBE and SSBE with respect to age, gender, ethnicity, BMI,and GERD symptom duration. Conclusions: The frequency of BE in a high-risk patient group (chronic GERD, majority white men, age > 50 years) who sought medical attention is 13.2%,with the majority (64%) having SSBE. These d ata suggest that the frequency of BE in patients with GERD has not changed.The t rue prevalence of BE in the general population, including those who do not seek care, is undoubtedly lower, currently and historically. The majority of patients with BE are overweight and have a hiatal hernia. Demographic data for patients with LSBE and SSBE are similar, indicating that these are a continuum of the sam e process.

内镜下胆囊支架置入治疗末期肝病患者的症状性胆囊疾病

Endoscopic stent insertion into the gallbladder entails placement of a double-pigtail polyethylene stent between the gallbladder and the duodenum at ERCP. This proceduremay be an effective temporary measure in patients with severe comorbid conditions, especially end-stage liver disease, that subsequently allows more definitive therapy, including liver transplantation. The records for 29 patients who underwent attempted endoscopic gallbladder stent insertion between May 1999 and May 2004 were reviewed retrospectively. Mean patient age was 47 years; 86%of the patients were listed for liver transplantation, with a mean model for end-stage liver disease score of 15; 72%had Child’s class B cirrhosis. Indications for gallbladder stent placement included recurrent biliary colic (69%), acute cholecystitis (17%), acalculous cholecystitis (7%), and gallstone pancreatitis (7%). Of the 29 patients who underwent ERCP, stent placement was successful in 26 (90%). Median follow-up was 9.4 months (range 0.1-40.5 months). Of those who had a stent placed, 6 (22%) subsequently underwent liver transplantation and another 15 (56%) were alive, most awaiting liver transplantation. Only 3 patients had late a complication or recurrence of biliary symptoms after stent placement. Endoscopic stent placement in the gallbladder is a safe and an effective palliative treatment for patients with symptoms caused by gallbladder disease who are poor surgical candidates.

喉-食管上括约肌收缩反射随年龄增长而减弱

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.