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OC1.03.4 ESOPHAGEAL BOLUS RETENTION IN PATIENTS WITH CHESTPAIN, DYSPHAGIA AND GERD: STUDIES USING COMBINED IMPEDANCE-MANOMETRY TESTING
S14
Abstracts / Digestive and Liver Disease 40S (2008), S1–S195
a sensitivity of 96.4%. The agreement between endomicroscopic and histological results was substantial (k=0.74). Conclusions: Confocal laser endomicroscopy provides in-vivo diagnosis of Barrett’s esophagus and associated neoplasia. Because of the possibility of studying larger surface areas of the mucosa and the chance for more effective target biopsies, confocal laser endomicroscopy may lead to significant improvements in the in-vivo screening and surveillance of Barrett’s esophagus. # A. Oesophagus 4. Barrett
conventional (impedance-)manometry in the evaluation of patients with non-achalasia, non-obstructive dysphagia. # N. Motility and nerve-gut interactions 1. Upper GI tract
OC1.03.4 ESOPHAGEAL BOLUS RETENTION IN PATIENTS WITH CHESTPAIN, DYSPHAGIA AND GERD: STUDIES USING COMBINED IMPEDANCE-MANOMETRY TESTING E. Savarino ∗ ,1 , D. Pohl 2 , M. Ribolsi 2 , P. Zentilin 1 , C. Mansi 1 , R. Tutuian 2 , V. Savarino 1
OC1.03.3 ESOPHAGEAL BOLUS RETENTION TIME: A NOVEL APROACH TO EVALUATE PATIENTS WITH NON-OBSTRUCTIVE DYSPHAGIA (NOD)
1 Cattedra
E. Savarino 1 , D. Pohl 2 , M. Ribolsi 2 , P. Zentilin 1 , M. Di Benedetto 1 , R. Tutuian 2 , C. Mansi 1 , V. Savarino 1
Background and aim: Esophageal motility abnormalities and abnormal bolus transit are frequently encountered in patients with esophageal symptoms. There are limited data on the site of bolus retention and possible correlation between symptoms and bolus retention site. Combined impedance-manometry (MII-EM) measures esophageal peristalsis and bolus transit without the use of radiation allowing evaluation of a large number of swallows. Aim: To evaluate differences in bolus retention patterns in patients with chest pain, dysphagia and GERD symptoms. Material and methods: Combined MII-EM testing was used to measure bolus presence at 2, 5, 10, 15 and 20 cm above the lower esophageal sphincter (LES) during 10 liquid and 10 bread swallows in recumbent position. The highest Eraflux item score was used to classify patients as presenting primarily for chestpain, dysphagia or GERD symptoms. Bolus retention at one site was declared if bolus entered but did not exit that site. Complete bolus transit was declared if the bolus entered the most proximal site (20 cm above the LES) and exited all four distal impedance-measuring sites. Incomplete bolus transit was considered if the bolus did not exit any one of the four distal impedance-measuring sites. Results: Of 85 patients (48 f, mean age 49, range 16-81) 23 presented primarily with chestpain, 40 with GERD symptoms and 22 with dysphagia. Dysphagia patients had a higher proportion of saline swallows with incomplete bolus transit (28%) compared to patients with chest pain (17%) and GERD symptoms (10%; p<0.01). Liquid bolus retention in the proximal esophagus was more common in patients with dysphagia and chestpain than in GERD patients. The highest percentage of bolus retention was noticed in patients with dysphagia (Table 1).
1 Cattedra
di Gastroenterologia - Università di Genova, Genova; of Gastroenterology and Hepatology, University Hospital Zurich, Zurich
2 Division
Background and aim: Using small standardized swallows 20-30 seconds apart during esophageal manometry is considered an inadequate reproduction of physiologic swallowing activity during a meal. Combined impedance manometry (MII-EM) is a clinically available tool to evaluate esophageal function by characterizing esophageal persistalsis and bolus transit. Evaluating esophageal bolus transit and/or retention during a free meal could provide a better way to evaluate patients with non-obstructive dysphagia (NOD). Aim: To compare esophageal bolus presence during a meal in patients with non-obstructive dysphagia and healthy volunteers using combined MII-EM. Material and methods: Healthy volunteers (HV) and NOD patients were evaluated using solid state combined MII-EM catheter with 5 pressure channels and 5 impedance segments. Bolus presence data were recorded 2, 5, 10, 15 and 20 cm above the lower esophageal sphincter (LES). After completion of 10 saline (5ml each) and 10 viscous (5ml each) swallows subjects were asked to eat 2 slices of bread and 200 ml of orange juice in sitting position at their normal pace. Manometric and bolus transit abnormalities were evaluated according to previously published criteria (1). Meal periods were evaluated by manually summating, at each impedance level, the time elapsed between bolus entry and bolus exit (bolus presence time) for each swallow. The hereby obtained esophageal bolus presence time at each level was expressed as percentage of total meal duration. Patients with achalasia were not included in the study. Results: Twenty healthy volunteers (9 f, age 28±1.4 years) and 15 NOD patients (9 f, age 46.1±3.0 years) completed the study. Esophageal manometry and bolus transit finding during saline and viscous swallows were similar in patients with NOD patients and HV. Patients with NOD had longer %time bolus retention during the meal compared to healthy volunteers (Table 1). Table 1 Bolus retention during a meal (% time) Distance above LES Healthy volunteers Dysphagia patients p-value (N=20) (N=15) (unpaired T-test) 20cm 15cm 10cm 5cm 2cm
32.1±3.1 36.9±3.1 36.6±2.7 34.1±2.3 35.6±2.7
47.6±4.2 54.2±3.8 47.0±3.4 48.1±3.7 51.7±4.1
0.005 0.001 0.022 0.002 0.002
Data are presented as mean ± SEM.
Conclusions: Quantifying esophageal bolus retention during a standardized meal consumed “ad libitum” is superior to and might replace
di Gastroenterologia - Università di Genova, Genova; of Gastroenterology and Hepatology, University Hospital Zurich, Zurich 2 Division
Table 1. Percentage of swallows retained at a given site during saline and bread swallows MII-site
Saline
p value
Chest- Dys- GERD pain phagia 20 cm 15 cm 10 cm 5 cm 2 cm
8% 14% 6% 8% 3%
10% 19% 18% 10% 9%
4% 8% 4% 4% 4%
Bread
p value
Chest- Dys- GERD pain phagia <0.01 <0.01 <0.01 <0.05 <0.03
39% 37% 20% 18% 16%
24% 35% 36% 32% 31%
21% 21% 30% 20% 19%
<0.01 <0.01 <0.01 <0.01 <0.01
Conclusions: The site of bolus retention has a major impact on the character of esophageal discomfort. Thus bolus retention in the proximal esophagus might be perceived more often as chestpain while bolus retention in the distal esophagus might be perceived as dysphagia. # N. Motility and nerve-gut interactions 1. Upper GI tract
Abstracts / Digestive and Liver Disease 40S (2008), S1–S195
a sensitivity of 96.4%. The agreement between endomicroscopic and histological results was substantial (k=0.74). Conclusions: Confocal laser endomicroscopy provides in-vivo diagnosis of Barrett’s esophagus and associated neoplasia. Because of the possibility of studying larger surface areas of the mucosa and the chance for more effective target biopsies, confocal laser endomicroscopy may lead to significant improvements in the in-vivo screening and surveillance of Barrett’s esophagus. # A. Oesophagus 4. Barrett
conventional (impedance-)manometry in the evaluation of patients with non-achalasia, non-obstructive dysphagia. # N. Motility and nerve-gut interactions 1. Upper GI tract
OC1.03.4 ESOPHAGEAL BOLUS RETENTION IN PATIENTS WITH CHESTPAIN, DYSPHAGIA AND GERD: STUDIES USING COMBINED IMPEDANCE-MANOMETRY TESTING E. Savarino ∗ ,1 , D. Pohl 2 , M. Ribolsi 2 , P. Zentilin 1 , C. Mansi 1 , R. Tutuian 2 , V. Savarino 1
OC1.03.3 ESOPHAGEAL BOLUS RETENTION TIME: A NOVEL APROACH TO EVALUATE PATIENTS WITH NON-OBSTRUCTIVE DYSPHAGIA (NOD)
1 Cattedra
E. Savarino 1 , D. Pohl 2 , M. Ribolsi 2 , P. Zentilin 1 , M. Di Benedetto 1 , R. Tutuian 2 , C. Mansi 1 , V. Savarino 1
Background and aim: Esophageal motility abnormalities and abnormal bolus transit are frequently encountered in patients with esophageal symptoms. There are limited data on the site of bolus retention and possible correlation between symptoms and bolus retention site. Combined impedance-manometry (MII-EM) measures esophageal peristalsis and bolus transit without the use of radiation allowing evaluation of a large number of swallows. Aim: To evaluate differences in bolus retention patterns in patients with chest pain, dysphagia and GERD symptoms. Material and methods: Combined MII-EM testing was used to measure bolus presence at 2, 5, 10, 15 and 20 cm above the lower esophageal sphincter (LES) during 10 liquid and 10 bread swallows in recumbent position. The highest Eraflux item score was used to classify patients as presenting primarily for chestpain, dysphagia or GERD symptoms. Bolus retention at one site was declared if bolus entered but did not exit that site. Complete bolus transit was declared if the bolus entered the most proximal site (20 cm above the LES) and exited all four distal impedance-measuring sites. Incomplete bolus transit was considered if the bolus did not exit any one of the four distal impedance-measuring sites. Results: Of 85 patients (48 f, mean age 49, range 16-81) 23 presented primarily with chestpain, 40 with GERD symptoms and 22 with dysphagia. Dysphagia patients had a higher proportion of saline swallows with incomplete bolus transit (28%) compared to patients with chest pain (17%) and GERD symptoms (10%; p<0.01). Liquid bolus retention in the proximal esophagus was more common in patients with dysphagia and chestpain than in GERD patients. The highest percentage of bolus retention was noticed in patients with dysphagia (Table 1).
1 Cattedra
di Gastroenterologia - Università di Genova, Genova; of Gastroenterology and Hepatology, University Hospital Zurich, Zurich
2 Division
Background and aim: Using small standardized swallows 20-30 seconds apart during esophageal manometry is considered an inadequate reproduction of physiologic swallowing activity during a meal. Combined impedance manometry (MII-EM) is a clinically available tool to evaluate esophageal function by characterizing esophageal persistalsis and bolus transit. Evaluating esophageal bolus transit and/or retention during a free meal could provide a better way to evaluate patients with non-obstructive dysphagia (NOD). Aim: To compare esophageal bolus presence during a meal in patients with non-obstructive dysphagia and healthy volunteers using combined MII-EM. Material and methods: Healthy volunteers (HV) and NOD patients were evaluated using solid state combined MII-EM catheter with 5 pressure channels and 5 impedance segments. Bolus presence data were recorded 2, 5, 10, 15 and 20 cm above the lower esophageal sphincter (LES). After completion of 10 saline (5ml each) and 10 viscous (5ml each) swallows subjects were asked to eat 2 slices of bread and 200 ml of orange juice in sitting position at their normal pace. Manometric and bolus transit abnormalities were evaluated according to previously published criteria (1). Meal periods were evaluated by manually summating, at each impedance level, the time elapsed between bolus entry and bolus exit (bolus presence time) for each swallow. The hereby obtained esophageal bolus presence time at each level was expressed as percentage of total meal duration. Patients with achalasia were not included in the study. Results: Twenty healthy volunteers (9 f, age 28±1.4 years) and 15 NOD patients (9 f, age 46.1±3.0 years) completed the study. Esophageal manometry and bolus transit finding during saline and viscous swallows were similar in patients with NOD patients and HV. Patients with NOD had longer %time bolus retention during the meal compared to healthy volunteers (Table 1). Table 1 Bolus retention during a meal (% time) Distance above LES Healthy volunteers Dysphagia patients p-value (N=20) (N=15) (unpaired T-test) 20cm 15cm 10cm 5cm 2cm
32.1±3.1 36.9±3.1 36.6±2.7 34.1±2.3 35.6±2.7
47.6±4.2 54.2±3.8 47.0±3.4 48.1±3.7 51.7±4.1
0.005 0.001 0.022 0.002 0.002
Data are presented as mean ± SEM.
Conclusions: Quantifying esophageal bolus retention during a standardized meal consumed “ad libitum” is superior to and might replace
di Gastroenterologia - Università di Genova, Genova; of Gastroenterology and Hepatology, University Hospital Zurich, Zurich 2 Division
Table 1. Percentage of swallows retained at a given site during saline and bread swallows MII-site
Saline
p value
Chest- Dys- GERD pain phagia 20 cm 15 cm 10 cm 5 cm 2 cm
8% 14% 6% 8% 3%
10% 19% 18% 10% 9%
4% 8% 4% 4% 4%
Bread
p value
Chest- Dys- GERD pain phagia <0.01 <0.01 <0.01 <0.05 <0.03
39% 37% 20% 18% 16%
24% 35% 36% 32% 31%
21% 21% 30% 20% 19%
<0.01 <0.01 <0.01 <0.01 <0.01
Conclusions: The site of bolus retention has a major impact on the character of esophageal discomfort. Thus bolus retention in the proximal esophagus might be perceived more often as chestpain while bolus retention in the distal esophagus might be perceived as dysphagia. # N. Motility and nerve-gut interactions 1. Upper GI tract