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ABSTRACT Objective: To describe the correlation between the residues, their anatomical location and the presence of laryngotracheal penetration and aspiration in patients after supracricoid laryngectomy undergoing cricohyoidoepiglotopexy reconstruction. Methods: This study included 70 patients treated by supracricoid laryngectomy with cricohyoidoepiglotopexy reconstruction in a referral national cancer hospital. The patients were submitted to swallowing videofluoroscopy, and the findings were classified by the penetration and aspiration scale. The images were described observing the presence or absence of residues and their anatomical location. Results: The prevalence of penetration in this study was 68.6% and aspiration was 34.3%. An association was found between the presence of residue on the tongue (p=0.005), posterior pharyngeal wall (p=0.013), pyriform recesses (p=0.002), valecula (p=0.061), and laryngeal penetration. The residue in the upper esophageal sphincter (p=0.039) was associated with the occurrence of laryngotracheal aspiration. Conclusion: Patients undergoing supracricoid laryngectomy with cricohioidoepiglotopexy reconstruction have food residues in different anatomical regions after swallowing. Penetration was associated with the presence of residues on the base of the tongue and posterior pharyngeal wall. Aspiration was associated with the presence of residues in the upper esophageal sphincter.
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Humans , Deglutition Disorders/surgery , Deglutition Disorders/etiology , Larynx/surgery , Deglutition , Laryngectomy/methodsABSTRACT
Objective:To investigate reflux symptom index (RSI), reflux finding score (RFS), esophageal motility and to correlate them with laryngopharyngeal reflux in patients with vocal cord polyps, providing guidance for clinical study.Methods:A total of 100 patients with vocal cord polyps who received treatment from January 2018 to January 2020 in Jiangshan People's Hospital were included in the observation group. A total of 100 healthy controls who concurrently received physical examination were included in the control group. RSI and RFS were used to preliminarily evaluate laryngopharyngeal reflux. The characteristics of esophageal motility and the pressure of upper and lower sphincter were monitored. The correlation between RSI, RFS, esophageal motility and laryngopharyngeal reflux was analyzed.Results:In the observation group, 35.00% of patients had RSI > 13 points, and 30.00% of patients had RFS > 7 points. The RSI and RFS in the observation group were significantly higher than those in the control group [RSI: (24.17 ± 1.14) points vs. (7.28 ± 12) points; RFS: (17.59 ± 1.52) points vs. (4.28 ± 0.21) points, t = 147.344, 86.742, both P < 0.05)]. The time to upper sphincter relaxation recovery and the duration of upper sphincter relaxation in the observation group were significantly shorter than those in the control group ( t = 5.373, 4.660, both P < 0.05). The intra pellet pressure in the observation group was significantly greater than that in the control group ( t = 2.186, P < 0.05). The length of the lower sphincter in the observation group was significantly shorter than that in the control group ( t = 4.977, P < 0.05). Correlation analysis showed that RSI was positively correlated with foreign body sensation in the throat, continuous throat clearing, nasal reflux or phlegm ( r = 0.640, 0.649, 0.507, all P < 0.05). RFS was positively correlated with disappearance of laryngeal chamber, posterior commissure hyperplasia and vocal cord edema ( r = 0.742, 0.516, 0.547, all P < 0.05). Conclusion:RSI and RFS of patients with vocal cord polyps are positively correlated with laryngopharyngeal reflux. Some patients with vocal cord polyps have dysfunction and abnormal structure of upper and lower esophageal sphincter as well as laryngopharyngeal reflux. Therefore, reflux symptom index, reflux finding score and esophageal motility can be used together to diagnose laryngopharyngeal reflux and increase the diagnosis accuracy
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Objective@#To clarify the correlation between the clinical characteristics, esophageal motility features and esophageal acid exposure in patients with ineffective esophageal motility (IEM).@*Methods@#From January 2016 to March 2018, at Peking University First Hospital, 22 IEM patients diagnosed by esophagus high-resolution manometry (HRM) and 24 individuals with normal HRM results were enrolled. Clinical features, parameters of esophageal HRM and results of esophageal 24-hour pH monitoring of IEM patients and the individuals with normal HRM results were compared. According to the median distal contraction integral (DCI) of ten swallows, the IEM patients were divided into mild-IEM group (DCI 250-450 mmHg·s·cm (1 mmHg=0.133 kPa)) (14 cases) and severe-IEM group (DCI<250 mmHg·s·cm) (eight cases). The clinical features and esophageal motility were compared between normal HRM group, mild-IEM group and severe-IEM group. T test, chi-square test and one-way analysis of various were used for statistical analysis.@*Results@#The age of IEM group was older than that of normal HRM group ((64.5±11.2) years vs. (50.3±18.2) years), and the difference was statistically significant (t=-3.135, P=0.003). The lower esophageal sphincter pressure (LESP) of IEM group was lower than that of normal HRM group ((17.0±6.8) mmHg vs. (22.3±7.2) mmHg), and the difference was statistically significant (t=2.516, P=0.016). There were 15 cases in normal HRM group and 14 patients in IEM group who underwent esophageal 24-hour pH monitoring and there were five and two patients with abnormal acid exposure time (AET) in normal HRM group and IEM group, respectively. The length of proximal esophageal body (PEB) pressure zone of severe-IEM group was shorter than those of normal HRM group and mild-IEM group ((2.8±1.5) cm vs.(4.2±0.7) cm and (4.6±0.9) cm), and the differences were statistically significant (t=2.397 and 3.432, P=0.044 and 0.003). The integrated relaxation pressure (IRP) and LESP of normal HRM group were both higher than those of mild-IEM group ((9.3±2.9) mmHg vs. (7.2±3.3) mmHg, (22.3±7.2) mmHg vs. (15.4±7.1) mmHg), and the differences were statistically significant (t=2.148 and 2.843, P=0.038 and 0.007). There were six and eight patients in mild-IEM group and severe-IEM group who underwent esophageal 24-hour pH monitoring, respectively, and two patients in mild-IEM had abnormal AET.@*Conclusions@#The LESP of IEM patients is low. The clinical features and AET of IEM patients are not associated with the severity of IEM. In patients with severe IEM, the proximal and distal esophageal contractility is weakened, and the length of PEB pressure zone is shortened.
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Objective To clarify the correlation between the clinical characteristics,esophageal motility features and esophageal acid exposure in patients with ineffective esophageal motility (IEM). Methods From January 2016 to March 2018,at Peking University First Hospital,22 IEM patients diagnosed by esophagus high-resolution manometry (HRM ) and 24 individuals with normal HRM results were enrolled. Clinical features,parameters of esophageal HRM and results of esophageal 24-hour pH monitoring of IEM patients and the individuals with normal HRM results were compared. According to the median distal contraction integral (DCI)of ten swallows,the IEM patients were divided into mild-IEM group (DCI 250 - 450 mmHg · s · cm (1 mmHg = 0. 133 kPa))(14 cases)and severe-IEM group (DCI < 250 mmHg·s·cm)(eight cases). The clinical features and esophageal motility were compared between normal HRM group,mild-IEM group and severe-IEM group. T test,chi-square test and one-way analysis of various were used for statistical analysis. Results The age of IEM group was older than that of normal HRM group ((64. 5 ± 11. 2)years vs. (50. 3 ± 18. 2)years),and the difference was statistically significant (t = - 3. 135,P = 0. 003). The lower esophageal sphincter pressure (LESP)of IEM group was lower than that of normal HRM group ((17. 0 ± 6. 8)mmHg vs. (22. 3 ± 7. 2)mmHg),and the difference was statistically significant (t = 2. 516,P = 0. 016). There were 15 cases in normal HRM group and 14 patients in IEM group who underwent esophageal 24-hour pH monitoring and there were five and two patients with abnormal acid exposure time (AET)in normal HRM group and IEM group,respectively. The length of proximal esophageal body (PEB)pressure zone of severe-IEM group was shorter than those of normal HRM group and mild-IEM group ((2. 8 ± 1. 5 )cm vs. (4. 2 ± 0. 7 )cm and (4. 6 ± 0. 9)cm),and the differences were statistically significant (t = 2. 397 and 3. 432,P = 0. 044 and 0. 003). The integrated relaxation pressure (IRP)and LESP of normal HRM group were both higher than those of mild-IEM group ((9. 3 ± 2. 9 )mmHg vs. (7. 2 ± 3. 3 )mmHg,(22. 3 ± 7. 2 )mmHg vs. (15. 4 ± 7. 1)mmHg),and the differences were statistically significant (t = 2. 148 and 2. 843,P = 0. 038 and 0. 007). There were six and eight patients in mild-IEM group and severe-IEM group who underwent esophageal 24-hour pH monitoring,respectively,and two patients in mild-IEM had abnormal AET. Conclusions The LESP of IEM patients is low. The clinical features and AET of IEM patients are not associated with the severity of IEM. In patients with severe IEM,the proximal and distal esophageal contractility is weakened,and the length of PEB pressure zone is shortened.
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Objective To investigate upper esophageal sphincter (UES)abnormalities in patients with achalasia (AC),and to analyze the correlation between UES abnormalities and clinical symptoms, treatment efficacy.Methods From February 2012 to December 2014,158 patients with AC and received high resolution manometry (HRM)examination were retrospectivly analyzed.According to whether with UES abnormalities,patients were divided into UES normal group and UES abnormal group.Patients of UES abnormal group were sub-divided into UES hypotensive group (UES resting pressure104 mmHg)and impaired relaxation group (residual pressure>12 mmHg).Analysis of Variance,Kruskal-Wallis H test and Chi square test were performed to compare the clinical data and dynamic characteristics of the patients in each group. Results A total of 74 (46.8%)AC patients had UES abnormalities,the majority of whom were impaired relaxation (35 cases,47.3%).The age of patients in hypotensive group ((60.6 ± 10.1 )years)was significantly older than that of hypertensive group ((43.9 ±11 .1 )years)and impaired relaxation group ((46.8±16.3)years),and the disease course (10 years,4 to 30 years)was obviously longer than that of hypertensive group (6 years,1 to 10 years)and impaired relaxation group (8 years,3 to 15 years),and the differences were statistically significant (F = 7.983,H = 13.816,both P 0.05 ).The results of AC subtyping indicated that type Ⅱ AC accounted 55 .7% (88/158).Type Ⅱ AC cases number of UES normal group and abnormal group was 46 and 42 cases,both was majority (54.8% and 56.8%).Among these patients,123 patients finally received peroral endoscopic myotomy (POEM),47.2%(58/123 )of whom had abnormal UES.More than 85 % patients were satisfied at one month after the operation.And Eckardt scores significantly decreased.There was no significant difference in treatment efficacy between the two groups.Conclusions Most AC patients are with UES abnormality,and impaired relaxation is more common.There is no correlation between UES abnormalities and major symptoms.There is no predictive role of UES abnormalities in treatment efficacy of POEM in AC patients.
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BACKGROUND/AIMS: Swallowing is a complex function with the control of the swallowing center being located in the brain stem. Our aim in this investigation was to evaluate, in healthy volunteers, the oral and pharyngeal transit of 2 bolus volumes and 2 consistencies, and the influence of these boluses on the proportion of pharyngeal clearance duration/hyoid movement duration. METHODS: Videofluoroscopic evaluation of swallows was performed in 30 healthy volunteers, aged 29-77 years (mean 58 years). The subjects swallowed in duplicate of 5 mL and 10 mL of thick liquid barium and honey thick barium. We measured the duration of oral transit, pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement, oropharyngeal transit, and the relation pharyngeal clearance duration/hyoid movement duration. RESULTS: A 10 mL bolus volume caused a longer UES opening duration than a 5 mL bolus volume, for both consistencies. The pharyngeal transit was longer for honey thick bolus consistency than for thick liquid, with both the volumes of 5 mL and 10 mL. For pharyngeal clearance, the difference was significant only with the 10 mL bolus volume. There was no difference associated with bolus volume or consistency in the relation between pharyngeal clearance duration and hyoid movement duration. CONCLUSIONS: Increase in the swallowed bolus volume causes a longer UES opening duration and an increase in bolus consistency from thick liquid to honey thick causes a longer pharyngeal transit duration. The proportion between pharyngeal clearance and hyoid movement does not change with bolus volume or bolus consistency.
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Barium , Brain Stem , Deglutition , Esophageal Sphincter, Upper , Healthy Volunteers , Honey , Pharynx , SwallowsABSTRACT
Background:Besides typical gastroesophageal reflux symptoms,some reflux esophagitis( RE)patients also complain“morning sour taste in mouth”,but related studies are rare. Aims:To study the pathophysiology of RE with sour taste in mouth. Methods:Fifty-two RE patients with typical regurgitation symptom and confirmed by endoscopy from Mar. 2013 to Oct. 2013 at Tianjin Medical University General Hospital were enrolled. Patients were divided into two groups according to whether there was an existence of morning sour taste in mouth. Results of esophageal manometry and 24-hour esophageal impedance-pH monitoring were analyzed. Nine healthy volunteers who had esophageal manometry performed were served as controls. Results:Length of lower esophageal sphincter( LESL)was shortened and LES pressure( LESP)and effective peristalsis of esophageal body were decreased in both RE groups when compared with controls( P ﹤ 0. 05 ). Upper esophageal sphincter pressure( UESP)was significantly lower and more nocturnal reflux episodes occurred in RE group with sour taste than those without( P ﹤ 0. 05 );however,no significant differences in other manometric and reflux parameters were found between RE groups with and without sour taste(P﹥0. 05). Conclusions:Esophageal motility and reflux events in RE patients with morning sour taste in mouth are somewhat different from those without sour taste. Decrease in UESP might be an important pathophysiological mechanism of sour taste in mouth in RE patients.
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BACKGROUND/AIMS: The purpose of this study was to determine important manometric metrics for the analysis of pharyngeal and upper esophageal sphincter (UES) function and to investigate the effect of viscosity and other confounding factors on manometric results. METHODS: Manometric studies were performed on 26 asymptomatic volunteers (12 men and 14 women; age, 19-81 years). The manometric protocol included 5 water swallows (5 mL), 5 barium swallows (5 mL) and 5 yogurt swallows (5 mL). Evaluation of high-resolution manometry parameters including basal pressure of the UES, mesopharyngeal contractile integral (mesopharyngeal CI, mmHg . cm . sec), CI of the hypopharynx and UES (hypopharyngeal CI), relaxation interval of UES, median intrabolus pressure and nadir pressure at UES was performed using MATLAB. RESULTS: Mesopharyngeal CIs for barium and yogurt swallows were significantly lower than those for water swallows (both P < 0.05). Hypopharyngeal CIs for water swallows were significantly lower than those for barium swallows (P = 0.004), and median bolus pressure at UES for barium swallows was significantly higher than that for water and yogurt swallows (both P < 0.05). Furthermore, hypopharyngeal CI and median intrabolus pressure at UES were significantly related to age for 3 swallows (all P < 0.01 and P < 0.05, respectively). A significant negative correlation was also noted between nadir pressure at UES and age for water and yogurt swallows (all P < 0.05). CONCLUSIONS: Manometric measurement of the pharynx and UES varies with respect to viscosity. Moreover, age could be a confounding variable in the interpretation of pharyngeal manometry.
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Female , Humans , Male , Barium , Deglutition , Esophageal Sphincter, Upper , Fluoroscopy , Hypopharynx , Manometry , Pharynx , Relaxation , Swallows , Viscosity , Volunteers , Water , YogurtABSTRACT
Manometry of the pharynx and the upper esophageal sphincter (UES) provides important information on the swallowing mechanism, especially about details on the pharyngeal contraction and relaxation of the UES. However, UES manometry is challenging because of the radial asymmetry of the sphincter, and upward movement of the UES during swallowing. In addition, the rapidity of contraction of the pharyngoesophageal segment requires high frequency recording for capturing these changes in pressure; this is best done with the use of solid state transducers and high-resolution manometry. UES manometry is not required for routine patient care, when esophageal manometry is being performed. The major usefulness of UES manometry in clinical practice is in the evaluation of patients with oropharyngeal dysphagia.
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Humans , Contracts , Deglutition , Deglutition Disorders , Esophageal Sphincter, Upper , Manometry , Patient Care , Pharynx , Relaxation , TransducersABSTRACT
Objective To evaluate the feasibility and safety of double-lumen balloon catheter applied in patients with achalasia of cricopharyngeal muscle. Method Fifty patients with achalasia of cricopharyngeal muscle were randomly divided into experimental group and control group. All the patients received routine drug treatment,swallowing function training,feeding training and low frequency VitalStim electric stimulation. In addition,double-lumen balloon catheter and #14 urinary catheters were applied to patients in the experimental group and control group,respectively. The swallow water tests and video fluoroscopy swallowing study(VFSS) were used to evaluate the treatment effects,the electron-nasopharyngolaryngoscope was used to assess bleeding and swelling of mucous membrane,and VRS-5 was used to assess pain. Result After treatment,the scores of swallow water tests and VFSS were significantly better than those before treatment in both groups(P<0.05). There was no significant difference between the two groups(P>0.05). However,the incidence of complications was significantly higher in the control group than that of experimental group(P<0.05). Conclusion Both treatment methods can effectively relieve the achalasia of cricopharyngeal muscle,but modified double-lumen balloon catheter can reduce the incidence of complications.