Esophageal function testing 3Word格式.docx
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Esophageal function testing 3Word格式.docx
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ml.TherewassignificantlinearincreaseofBTTwithprogressivelylargervolumesofapplesauce,andBTTofapplesaucewaslongerthanforwater.BTTwassignificantlylongerwithlargemarshmallowsvs.smallandmediumandwaslongerthanforwater.BTTforicedwaterwassimilarto130°
Fwater.ApplesauceshowedasignificantlineardecreaseofCWVwithprogressivelylargervolumesandwasslowerthanwater.MarshmallowshowedsignificantlyslowerCWVwiththelargevs.small,andCWVforicewaterwassignificantlyslowerthan130°
Fwater.Therefore,BTTofliquidisconstant,whereasBTTofsemisolidandsolidarevolumedependentandlongerthanliquids.CWVofsemisolidsandsolidsareslowerthanliquids.CWVofcoldliquidsisslowerthanwarmliquids.MIIcanbeusedasadiscriminatingtestofesophagealfunction.
motility;
manometry;
esophagealcontraction
INTRODUCTION
ESOPHAGEALFUNCTIONHASBEENstudiedusingvarioustechnologies.Currently,manometryisthegoldstandardinevaluatingesophagealmotility.However,itislimitedtoonlythecontractilepatternsoftheesophagus(18).Pressurewavesofadequateamplitudeandsequenceofcontractionsensurethatthebolusiseffectivelysweptthroughtheesophagus.However,weakercontractions(<
30mmHg)arelikelytobeineffectiveforbolusmovement(4).Sincebolustransportcannotbeevaluatedbyesophagealmanometry,otherproceduresarenecessarytodeterminebolusmovementthroughtheesophagus.Scintigraphyandvideofluoroscopyarebothnoninvasiveproceduresthathavebeenusedtocomplimentesophagealmanometrybyvisualizingthetransitofthebolus.However,thesetechniquesarelimitedbyaccesstospecializedlaboratoriesandbyradiationexposure.Ultrafastcomputerizedtomographydynamicallyimagesthecomposition,distribution,andpropulsionofesophagealcontentsduringswallowing(14).Thistechnologyislimitedbytheeconomicandlogisticfactorsoftheequipmentalongwiththecomplexnatureofthemethodologyandinterpretationofresults.
Multichannelintraluminalimpedance(MII)isanewtechniquethathasbeenusedtoevaluatebolustransportandgastroesophagealreflux;
however,itsroleinesophagealfunctiontestinghasnotbeenwellstudied.Inthisexperiment,weaimedtoevaluateesophagealfunctionviabolustransporttime(BTT)andcontractionwavevelocity(CWV)ofvariousboluseshavingdifferentcharacteristics:
liquid,semisolid,andsolidboluses,pH2-8,temperature35-130°
F,volume1-20ml,andsize12-30mm.Also,wechallengedtheesophaguswithbethanecholtoseeifMIIcouldbeusedasadiscriminatingesophagealfunctiontest.
METHODS
TOP
ABSTRACT
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES
Subjects.Ten(5
males,5
females)healthysubjectswithameanageof34
yr(range22-51yr)hadtheimpedanceprobe(SandhillTechnologies)placedtransnasally,withthe2-cmrecordingsegmentslocatedat2,
4,
6,
8,
14,
and20
cmabovetheproximalborderofloweresophagealsphincter,previouslydeterminedbymanometry.Upperesophagealsphincterlocationwasnotdetermined,andthereforeintersphincterlengthforthestudysubjectswasnotknown.However,sincethemostproximalimpedanceelectrodewasplaced20
cmabovetheloweresophagealsphincter,weareconfidentthatsubjectsaccommodatedallsixrecordingsitesonthebasisofpriorstudiesperformedbyourgroupshowingthatnormalesophageallengthis22.9
±
0.2
cm(23.6
0.3
formalesand22.4
forfemales)(10a).
Allsubjectswerefastingfor6
h,werefreeofesophagealsymptoms,andwerenottakinganymedication.ThestudywasapprovedanddeemedethicalbytheGraduateHospitalInternalReviewBoard,andwrittenconsentwasobtainedfromallsubjects.
MII.Recently,MIIhasbeenintroducedasanewtechniquetostudyesophagealmotilityandbolustransport(16).Impedanceistheaverageelectricalresistancebetweentwoadjacentelectrodesandismeasuredusingaspecializedcatheter(Fig.1)witha2.1-mmdiameterconsistingofnineelectrodesthatmakeupsixmeasuringsegments,each2
cminlength.Theintraluminalelectricalimpedancebetweenthetwoelectrodesisinverselyproportionaltotheelectricalconductivityoftheluminalcontentsandthecross-sectionalarea.Ifahighlyconductivebolusarrivesatthemeasuringsegment(i.e.,saliva),impedancewilldecrease,andtheoppositewilloccurwitharesistivebolus(i.e.,air).Also,increasingtheluminaldiameter(i.e.,arrivalofbolusintothemeasuringsegment)resultsinanimpedancedrop,whereasaluminalnarrowing(i.e.,contractionwave)causesanimpedanceincrease(16).Therefore,MIIcanevaluateesophagealmotilityalongwithassessingbolustransportthroughouttheentireesophagusinrealtimewithouttheuseofradiation.
Viewlargerversion(11K):
[inthiswindow]
[inanewwindow]
Fig.1.
Thisschematicrepresentationshowsthelocationofthe6
measuringsegments[cmabovetheloweresophagealsphincter(LES)],whichare2
cminlength.Thecatheterconsistsof9
stainlesssteelformulatedrings,andimpedance(theoppositiontocurrentflow)iscalculatedbetween2
adjacentelectrodes.
Withtheprinciplesofimpedanceinmind,onecanunderstandthecharacteristicpatternproducedbyabolusswallow(Fig.2).Theesophagusstartsatarestingvalue(Fig.2A)thatrepresentsthecollapsedesophagealwallsonthecatheter.Whenaswallowisinitiated,airisalsoswallowed.Airseparatesfromthebolusandentersthemeasuringsegmentfirst,causinganincreaseinimpedance(Fig.2B).Afterthepassageofair,theactualboluscausesasharpdecreaseinimpedanceduetoitsconductivityanditseffectonluminaldilatation.Thebolusenters,traverses,andexitsthemeasuringsegment(Fig.2,C,D,andE,respectively).Afterthepassageofthebolus,thelumen-occludingcontraction(Fig.2F)causesanincreaseinimpedance.Ifthecontractionwavecompletelyclearsthebolusfromthesegment,areturntotheoriginalimpedancebaselineisseen(Fig.2G).Ifareturnisnotseen,onecanassumethatthebolushasnotbeensuccessfullypropagatedthroughthatsegment.Quantifyingtheintraluminalvolumewithimpedanceiscurrentlyunderinvestigation.
Viewlargerversion(5K):
Fig.2.
Impedancechangesduetobolustransit.Theesophagusstartsatarestingimpedancevalue(A)thatrepresentsthecollapsedesophagealwallsonthecatheter.Whenaswallowisinitiated,airisalsoswallowed.Airseparatesfromthebolusandentersthemeasuringsegmentfirst,causinganincreaseinimpedance(B).Afterthepassageofair,theactualboluscausesasharpdecreaseinimpedanceduetoitsconductivityanditseffectonluminaldilatation.Thebolusenters,traverses,andexitsthemeasuringsegment(C,D,andE,respectively).Afterthepassageofthebolus,thelumen-occludingcontraction(F)causesanincreaseinimpedance.Ifthecontractionwavecompletelyclearsthebolusfromthesegment,areturntotheoriginalimpedancebaselineisseen(G).
TheusefulnessofMIIinthestudyofesophagealmotilityhasbeensuccessfullyverifiedincomparativestudieswithvolunteerswiththeuseofmanometryandfluoroscopy.Thecontractionwaveasseenonimpedance(Fig.2F)iscorrelatedwiththemaximalpressureproducedduringsimultaneousmanometry,andthebolusentry,transit,andexit(Fig.2,C-E)withrespecttothemeasuringsegmenthavebeencorrelatedwithsimultaneousbariumswallow(12,17).
Studydesign.Differentboluseswithvaryingconsistencies(liquid,semisolid,andsolid)andcharacteristics(pHandtemperature)wereadministeredatdifferentvolumes(1-20ml)andsizes(12-30mm)whilethesubjectwasrecumbent.Sevencategoriesofbolusweretested:
1)sterilewater,pH5,
roomtemperature,2)sterilewater,pH2,
roomtemperature,3)sterilewater,pH8,
roomtemperature,4)sterilewater,pH5,
iced,5)sterilewater,pH5,
130°
F,6)applesauce(Mott'
s),and7)marshmallow(Jet-Puffed).SolutionsofpH2
andpH8
weremadebyadding1
NHCl(FisherScientific)or5
NNaOH(Titristar),respectively,tosterilewaterdropwiseduringtitrationwithacalibratedpHmeter(Corning215).ThepHofallsolutionswasverifiedbeforeeachsubjectstudy.Temperatureof130°
Fwasmaintainedusingaconstantwaterbath(Precision181).Icedsolutionswerepreparedbyplacingtwoicecubesmadefromsterilewaterinthe100-mlsolution.Thesolutionwasallowedtocoolfor15
mintogainappropriatetemperaturebeforeuse.Icecubeswerealwayspresentinthesolution,keepingthetemperatureapproximatelyinarangeof35-45°
F.
Typeofbolusadministeredwasrandomizedbyallowingthesubjecttoblindlydrawfromaboxthatcontainedpiecesofpaperwithallofthecategorynumbers.Accordingtothecategoryselected,themethodologywasdifferent.Aftercompletionofthecategory,thesubjectth
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