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W1859 Physiologic Changes in Esophageal Motility with Healthy Aging
clinical high resolution manometry protocol comprising 10 supine followed by 10 upright liquid swallows often triggered tLESRs immediately after patients sat up. Thus, we retrospectively analyzed the tLESR occurrence and integrity in 82 consecutive patients and 29 consecutive achalasics in terms of LES relaxation, CD inhibition, esophageal shortening and pressurization, and UES relaxation. Results are given as median (5th - 95th percentile). RESULTS: In addition to the 29 achalasics (integrated relaxation pressure >15 mmHg and aperistalsis), 13 patients had impaired EGJ relaxation with adequate peristalsis (EGJ obstruction). Achalasics, consistent with early disease, had no esophageal dilatation or food retention. The sitting up maneuver triggered tLESR in most patients (Table). Achalasia “tLESRs” exhibited a selective LESR defect despite all other associated tLESR components (CD inhibition, esophageal shortening and UESR) being preserved (Table). There were no differences in the durations of “tLESR” (p = 0.2) or ensuing UES relaxation (p = 0.6) in achalasia. Esophageal pressurization during “tLESR” was greater in achalasia (8, -3 - 70 mmHg) compared to EGJ obstruction patients (2, -2 - 9 mmHg) or normals (3, -1 - 8 mmHg) (p<0.01) and related to the phenomenon of compression. CONCLUSION: Partial tLESRs occur in early achalasics supporting the idea of a selective neural defect of the inhibitory myenteric plexus neurons. The esophagus is pressurized during “tLESR” in early achalasics by the esophageal shortening rather than by reflux and elicits UESR suggesting integrity of proximal reflex pathways. tLESRs were normal in most EGJ obstruction patients suggesting a criterion for differentiating them from early achalasia.
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Background: The incidence of esophageal dysphagia increases with age, but the associated motor patterns are unclear. Limited data indicate increased basal lower esophageal sphincter (LES) pressures and incomplete relaxation1 in elderly compared to young dysphagic patients. It is, however, unclear whether these changes are specific to dysphagia or reflect normal aging. Aim: To determine the effects of age on lower esophageal motor function in asymptomatic healthy humans. Methods: Esophageal perfusion manometry (16 pressure channels, 8 side-holes (3cm apart) spanning the esophageal body and 8 (1cm apart) across the LES) was performed in 7 older (4M, aged 79.6 ± 1.6 yrs) and 7 young (4M, 24 ± 1.8 yrs) asymptomatic healthy humans, during 10 liquid boluses (5ml water) in both right lateral (RL) and upright postures, and 5 standardized solid boluses (bread) sitting. Recordings were analysed for basal LES pressure (BLESP), LES nadir pressure, time to recovery of BLESP, proximal (6cm below upper esophageal sphincter) and distal (4cm above LES) esophageal peristaltic amplitudes and duration. Data are mean ± SEM. Comparison by t-test. Results: BLESP was reduced in older (12.9 ± 1.8 mmHg) compared to younger (19.1 ± 1.9 mmHg; P=0.038) subjects. The number of incomplete LES relaxations were higher in the older group with liquid swallows in both postures (RL:P=0.013; upright:P=0.006), and a strong trend with solids (P=0.07). Recovery of the LES after relaxation was slower in the older group after liquid boluses in both RL (10.7 ± 0.5 vs. 9.0 ± 0.4 sec, P=0.03) and upright (10.4 ± 0.6 vs. 8.1 ± 0.2 sec, P=0.006) postures, and also following solid boluses (12.0 ± 0.9 vs. 9.2 ± 0.3, P=0.04). Total duration of esophageal peristalsis was longer in older subjects with liquid boluses in RL (11.2 ± 0.8 vs. 9.1 ± 0.5 sec, P=0.049) and upright (10.6 ± 1.0 vs. 7.9 ± 0.4 sec, P=0.03) postures, with a similar trend for solids (11.1 ± 1.2 vs. 9.4 ± 0.4 sec, P=0.1). There were no differences in proximal or distal esophageal amplitudes or LES nadir pressures between age groups. Conclusion: Overall esophageal function appears well preserved in the elderly. In older dysphagic patients, the previously reported finding of incomplete LES relaxation may reflect normal ageing, as this is also seen in asymptomatic older individuals. As basal LES pressures are reduced in healthy older humans, the increase in BLESP in older dysphagic patients is a potential contributor to swallow dysfunction. The impact of slower peristaltic sequences on transit requires further investigation. 1Mountifield RE et al. Oesophageal motor correlates of dysphagia in elderly patients. Gastroenterology 2007; A-100.
* p<0.01, complete LESR seen in 2 achalasics W1858 Impaired Esophageal Smooth Muscle Contractility and Elasticity in Patients with Systemic Sclerosis Donghua Liao, Flemming H. Gravesen, Gerda E. Villadsen, Hans Gregersen Introduction: Systemic sclerosis(SS) is a connective tissue disease characterized by degenerative changes and fibrosis in many organs. Esophageal smooth muscle atrophy, fibrotic deposits and/or dysmotility with impaired peristalsis are found in 75% of the patients. The motor function of the gastrointestinal tract has primarily been studied using manometry and radiography. However it does not provide detailed information about the muscle properties similar to data assessed from studies in muscle strips In Vitro. The aim was to develop a new muscle function analysis of force-length relationship in the esophagus based on impedance planimetric measurement of pressure and cross-sectional area(CSA). Methods:Eight healthy controls and six SS patients were included. The probe with a bag and electrodes for impedance planimetry was positioned in the lower part of the esophagus. Pressure-controlled stepwise distension with bag pressures from 5-50cmH2O was applied. The pressure-CSA and the work output (The area of tension-CSA loops) were analyzed. Results:The pressure CSA loops differed between the two groups. The tension-stretch ratio loops for the SS patient were located to the left of the loops in the healthy subjects, indicating a stiffer wall in the SS patients. The loops of the SS patients were smaller than the loops obtained in the controls, indicating impaired muscle function in the SS patients. The work produced by esophageal contractions was lower in SS patients (dashed line in figure) than in healthy volunteers (solid line)(P<0.001). In conclusion significant changes in esophageal stiffness and muscle properties were found between SS patients and controls. The new type of analysis of bag distension data will contribute a more complete picture of esophageal properties in health and disease in the future.
W1860 Differences in Proximal and Distal Esophageal Sensation in Normal Subjects Identified By Barostat Distention Margaret Freede, Howard M. Proskin, Sattar M. Zubaidi, Philip B. Miner Background: Alterations in gastrointestinal sensation profoundly influence morbidity in functional gastrointestinal disorders. Balloon distention in the gastrointestinal tract has been used to test visceral sensitivity since the development of latex balloons. Recently, the development of the electronic Barostat allows measurement of balloon volume and pressure accurately enough to determine differences between patients with functional disease and normal subjects. The esophagus is a unique organ with distinct innervation and muscle composition in the proximal and distal esophagus. The distal esophagus, composed of smooth muscle, perceives visceral pain, and the distal portion of the esophagus, composed of striated muscle, perceives somatic pain. The aim of this study was to use the Barostat to compare first sensation and maximum tolerable sensation in proximal and distal esophagus in normal subjects. Methods: Twenty-four normal subjects were recruited to have two Barostat studies with balloon distention 5 cm above the LES and 3 cm below the UES. Sensory endpoints were 1st sensation, 1st discomfort, and maximum tolerable balloon distention. Of the 24 patients, 21 patients completed both procedures with evaluable data. Results: The averages of the two measurements were used to compose the following table. Conclusion: 1) The proximal esophagus is more sensitive to volume and pressure with balloon distention than the distal esophagus. 2) Careful placement of the balloon in esophageal distention is essential for barostat studies. 3) These findings suggest there may be important differences in the innervation and sensation between the proximal and distal esophagus.
W1861 Segmental Motor Patterns After Multiple Rapid Swallows On High Resolution Manometry Michael J. Hersh, Vladimir Kushnir, Sonal Kumar, C. Prakash Gyawali Multiple rapid swallows (MRS) inhibit esophageal peristalsis; a rebound excitatory response then promotes an exaggerated peristaltic sequence. High resolution manometry (HRM) has demonstrated two smooth muscle contraction segments in the esophageal body, the proximal (2nd segment) with cholinergic influences, and the distal (3rd segment) with predominantly inhibitory influences. Aim: To evaluate characteristics of smooth muscle contraction segments after MRS using HRM. Methods: HRM (solid state 36 sensor catheter system, Sierra Scientific, Los Angeles, CA) plots were evaluated to assess performance of contraction segments with 10 wet swallows and MRS in subjects with esophageal symptoms. MRS was performed with five 2 mL water swallows administered 2-3 seconds apart. Following MRS, peak contraction
A-741
AGA Abstracts
AGA Abstracts
Physiologic Changes in Esophageal Motility with Healthy Aging Laura K. Besanko, Carly Burgstad, Kenneth R. Lim, Richard Heddle, Alison C. Fraser, Robert J. Fraser
W1859
Background: The incidence of esophageal dysphagia increases with age, but the associated motor patterns are unclear. Limited data indicate increased basal lower esophageal sphincter (LES) pressures and incomplete relaxation1 in elderly compared to young dysphagic patients. It is, however, unclear whether these changes are specific to dysphagia or reflect normal aging. Aim: To determine the effects of age on lower esophageal motor function in asymptomatic healthy humans. Methods: Esophageal perfusion manometry (16 pressure channels, 8 side-holes (3cm apart) spanning the esophageal body and 8 (1cm apart) across the LES) was performed in 7 older (4M, aged 79.6 ± 1.6 yrs) and 7 young (4M, 24 ± 1.8 yrs) asymptomatic healthy humans, during 10 liquid boluses (5ml water) in both right lateral (RL) and upright postures, and 5 standardized solid boluses (bread) sitting. Recordings were analysed for basal LES pressure (BLESP), LES nadir pressure, time to recovery of BLESP, proximal (6cm below upper esophageal sphincter) and distal (4cm above LES) esophageal peristaltic amplitudes and duration. Data are mean ± SEM. Comparison by t-test. Results: BLESP was reduced in older (12.9 ± 1.8 mmHg) compared to younger (19.1 ± 1.9 mmHg; P=0.038) subjects. The number of incomplete LES relaxations were higher in the older group with liquid swallows in both postures (RL:P=0.013; upright:P=0.006), and a strong trend with solids (P=0.07). Recovery of the LES after relaxation was slower in the older group after liquid boluses in both RL (10.7 ± 0.5 vs. 9.0 ± 0.4 sec, P=0.03) and upright (10.4 ± 0.6 vs. 8.1 ± 0.2 sec, P=0.006) postures, and also following solid boluses (12.0 ± 0.9 vs. 9.2 ± 0.3, P=0.04). Total duration of esophageal peristalsis was longer in older subjects with liquid boluses in RL (11.2 ± 0.8 vs. 9.1 ± 0.5 sec, P=0.049) and upright (10.6 ± 1.0 vs. 7.9 ± 0.4 sec, P=0.03) postures, with a similar trend for solids (11.1 ± 1.2 vs. 9.4 ± 0.4 sec, P=0.1). There were no differences in proximal or distal esophageal amplitudes or LES nadir pressures between age groups. Conclusion: Overall esophageal function appears well preserved in the elderly. In older dysphagic patients, the previously reported finding of incomplete LES relaxation may reflect normal ageing, as this is also seen in asymptomatic older individuals. As basal LES pressures are reduced in healthy older humans, the increase in BLESP in older dysphagic patients is a potential contributor to swallow dysfunction. The impact of slower peristaltic sequences on transit requires further investigation. 1Mountifield RE et al. Oesophageal motor correlates of dysphagia in elderly patients. Gastroenterology 2007; A-100.
* p<0.01, complete LESR seen in 2 achalasics W1858 Impaired Esophageal Smooth Muscle Contractility and Elasticity in Patients with Systemic Sclerosis Donghua Liao, Flemming H. Gravesen, Gerda E. Villadsen, Hans Gregersen Introduction: Systemic sclerosis(SS) is a connective tissue disease characterized by degenerative changes and fibrosis in many organs. Esophageal smooth muscle atrophy, fibrotic deposits and/or dysmotility with impaired peristalsis are found in 75% of the patients. The motor function of the gastrointestinal tract has primarily been studied using manometry and radiography. However it does not provide detailed information about the muscle properties similar to data assessed from studies in muscle strips In Vitro. The aim was to develop a new muscle function analysis of force-length relationship in the esophagus based on impedance planimetric measurement of pressure and cross-sectional area(CSA). Methods:Eight healthy controls and six SS patients were included. The probe with a bag and electrodes for impedance planimetry was positioned in the lower part of the esophagus. Pressure-controlled stepwise distension with bag pressures from 5-50cmH2O was applied. The pressure-CSA and the work output (The area of tension-CSA loops) were analyzed. Results:The pressure CSA loops differed between the two groups. The tension-stretch ratio loops for the SS patient were located to the left of the loops in the healthy subjects, indicating a stiffer wall in the SS patients. The loops of the SS patients were smaller than the loops obtained in the controls, indicating impaired muscle function in the SS patients. The work produced by esophageal contractions was lower in SS patients (dashed line in figure) than in healthy volunteers (solid line)(P<0.001). In conclusion significant changes in esophageal stiffness and muscle properties were found between SS patients and controls. The new type of analysis of bag distension data will contribute a more complete picture of esophageal properties in health and disease in the future.
W1860 Differences in Proximal and Distal Esophageal Sensation in Normal Subjects Identified By Barostat Distention Margaret Freede, Howard M. Proskin, Sattar M. Zubaidi, Philip B. Miner Background: Alterations in gastrointestinal sensation profoundly influence morbidity in functional gastrointestinal disorders. Balloon distention in the gastrointestinal tract has been used to test visceral sensitivity since the development of latex balloons. Recently, the development of the electronic Barostat allows measurement of balloon volume and pressure accurately enough to determine differences between patients with functional disease and normal subjects. The esophagus is a unique organ with distinct innervation and muscle composition in the proximal and distal esophagus. The distal esophagus, composed of smooth muscle, perceives visceral pain, and the distal portion of the esophagus, composed of striated muscle, perceives somatic pain. The aim of this study was to use the Barostat to compare first sensation and maximum tolerable sensation in proximal and distal esophagus in normal subjects. Methods: Twenty-four normal subjects were recruited to have two Barostat studies with balloon distention 5 cm above the LES and 3 cm below the UES. Sensory endpoints were 1st sensation, 1st discomfort, and maximum tolerable balloon distention. Of the 24 patients, 21 patients completed both procedures with evaluable data. Results: The averages of the two measurements were used to compose the following table. Conclusion: 1) The proximal esophagus is more sensitive to volume and pressure with balloon distention than the distal esophagus. 2) Careful placement of the balloon in esophageal distention is essential for barostat studies. 3) These findings suggest there may be important differences in the innervation and sensation between the proximal and distal esophagus.
W1861 Segmental Motor Patterns After Multiple Rapid Swallows On High Resolution Manometry Michael J. Hersh, Vladimir Kushnir, Sonal Kumar, C. Prakash Gyawali Multiple rapid swallows (MRS) inhibit esophageal peristalsis; a rebound excitatory response then promotes an exaggerated peristaltic sequence. High resolution manometry (HRM) has demonstrated two smooth muscle contraction segments in the esophageal body, the proximal (2nd segment) with cholinergic influences, and the distal (3rd segment) with predominantly inhibitory influences. Aim: To evaluate characteristics of smooth muscle contraction segments after MRS using HRM. Methods: HRM (solid state 36 sensor catheter system, Sierra Scientific, Los Angeles, CA) plots were evaluated to assess performance of contraction segments with 10 wet swallows and MRS in subjects with esophageal symptoms. MRS was performed with five 2 mL water swallows administered 2-3 seconds apart. Following MRS, peak contraction
A-741
AGA Abstracts
AGA Abstracts
Physiologic Changes in Esophageal Motility with Healthy Aging Laura K. Besanko, Carly Burgstad, Kenneth R. Lim, Richard Heddle, Alison C. Fraser, Robert J. Fraser