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ABSTRACT Background: The current definition for hypercontractile esophagus was arbitrarily set at the uppermost range in volunteers for a specific equipment. Objective: This study aims to critically analyze the concept of hypercontractile waves to redefine hypercontractile esophagus parameters. Methods: We reviewed 500 unselected and consecutive HRM tests (5000 waves) performed in a water -perfused system. Results: Mean distal contractility integral (DCI) was 825±1492 (0-42775) mmHg.cm.s, two standard deviations above average = 3810; 95th percentile = 2798 mmHg.cm.s. Conclusion: In healthy volunteers, two standard deviations above average is 4000 mmHg.cm.s, we thus suggest this value to define hypercontractile waves and define hypercontractile esophagus in a water-perfused HRM system.
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Objective To investigate the relationships among distal contractile integral (DCI), ineffective esophageal motility (IEM)and gastroesophageal reflux through high resolution manometry (HRM)in patients with gastroesophageal reflux disease (GERD).Methods A total of 69 patients with GERD were enrolled.All patients received HRM and 24 hour pH and impedance monitoring examination. Pearson correlation analysis was performed to analyze the correlation between DCI,number of invalid swallowing and DeMeester score.All the patients were divided into three groups according to the number of invalid swallowing in 10 times of 5 mL liquid swallowing test.Patients with 5 to 10 invalid swallowing was in IEM group (n=21),one to four was in abnormal motility group (n=19),and zero was in normal motility group (n=29).The t test was performed for comparison of average DCI,average DCI of residual effective swallowing,DeMeester score,acid reflux time,bolus exposure time and proximal reflux times among the three groups.Results Among the 69 patients with GERD,there was negative correlation between DCI and DeMeester score (r=-0.363,P =0.003)in 10 times of 5 mL liquid swallowing test;the number of invalid swallowing was positively correlated with DeMeester score (r=0.374,P =0.002). The mean DCI in 10 times of 5 mL liquid swallowing of normal motility group,abnormal motility group and IEM group was (1 458.96±545 .10),(986.48 ±577.50)and (288.50 ±167.25 )mmHg·s·cm, respectively,and that of IEM group was lower than normal motility group and abnormal motility group (t =-11 .42 and -2.12,both P <0.05).The average DCI of residual effective swallowing of normal motility group,abnormal motility group and IEM group was (1 458.96 ± 545 .10 ),(1 187.90 ± 669.40)and (450.78 ±350.73 )mmHg ·s ·cm,respectively,and that of IEM group was also lower than normal motility group and abnormal motility group (t = -8.05 and -5 .27,both P <0.01 ).The DeMeester score of IEM group (15 .42±8.79)was higher than that of normal motility group (6.34±3.45),and the difference was statistically significant (t=2.43,P <0.05).The acid reflux time and bolus exposure time of IEM group were (54.93 ± 37.07 )min and (0.64 ±0.49 )%,respectively,which were longer than abnormal motility group ((37.37±22.66)min,(0.52 ±0.24)%)and normal motility group ((21 .22 ± 13.98)min,(0.39 ±0.14)%),and the differences were statistically significant (t =2.36,2.17,2.60 and 2.54,all P <0.05).The total number of reflux of IEM group and abnormal motility group were 67.10± 32.94 and 57.26±38.90,which were both more than that of normal motility group (44.61 ±23.84),and the differences were statistically significant (t =2.48 and 2.17,both P <0.05 ).Conclusions DCI and the number of invalid swallowing can predict reflux condition of GERD patients in a certain degree.The contraction strength of esophageal body was the weakest and esophageal clearance was the worst in IEM group.
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Esophageal manometry is considered the gold standard for assessing esophageal motor function. Although conventional manometry has been widely used to evaluate esophageal motor function, this is not fully satisfactory for explaining esophageal symptoms. High-resolution manometry (HRM) is designed to overcome the limitations of conventional manometric systems with advanced technologies. A solid-state HRM assembly with 36 solid-state sensors spaced at 1 cm intervals (Sierra Scientific Instruments Inc., Los Angeles, CA, USA) has been widely used around the world. Calibration and post-study thermal correction should be performed at each test. The HRM assembly was passed transnasally and positioned to record from the hypopharynx to the stomach. After a 5 minutes resting period to assess basal sphincter pressure, 5 mL water swallows are obtained in a supine posture. The interpretation of HRM data is still being refined. Recently, the HRM Classification Working Group revised the Chicago classification based on a systematic analysis of motility patterns in 75 control subjects and 400 consecutive patients. The below will show you a summary of the new Chicago classification of distal esophageal motility disorders to provide a practical way of interpreting HRM.