What is normal oesophageal motility? An ambulatory study.

BACKGROUND: Our aim was to establish normal values for wave characteristics and patterns in long-term ambulatory oesophageal body motility. METHODS: A pressure sensor was positioned in the pharynx or cricopharyngeus for swallow detection. Oesophageal body pressures were recorded 5, 10, and 15 cm above the lower oesophageal sphincter. Contraction patterns and wave characteristics from eating, drinking, and postprandial, fasting, and supine periods in 16 healthy subjects were studied. RESULTS: Contraction patterns were similar during eating and drinking periods or fasting and postprandial periods (P > 0.05). Wave characteristics during each period differed significantly in amplitude, duration, area under the curve, or peristaltic velocity (P < 0.05). During the eating period the amplitude and area under the curve were greatest, and peristaltic velocity was slowest compared with all other periods. CONCLUSIONS: Data from the eating and drinking periods or the fasting and postprandial periods can be combined for contraction pattern analysis but not for wave characteristic analysis, for which data from different periods should be analysed separately.

Oesophageal motor responses to gastro-oesophageal reflux in healthy controls and reflux patients.

AIMS: To compare oesophageal motor responses to gastro-oesophageal reflux (GOR) in 16 healthy controls (group 1) and 25 reflux patients, 15 without (group 2) and 10 with (group 3) oesophagitis. METHODS: All subjects underwent 24 hour ambulatory oesophageal pH measurements (5 cm above the lower oesophageal sphincter (LOS)) combined with pressure monitoring (5, 10, and 15 cm above the LOS for oesophageal body motility and 27 cm above the LOS for voluntary swallow detection). Contraction patterns (peristaltic, simultaneous, isolated, mixed type, and non-transmitted swallows) and peristaltic contraction wave characteristics (amplitude, duration, and velocity) during GOR were compared in the three groups. RESULTS: The average number of motor activities per minute was significantly higher in group 1 (p < 0.05). In all groups, the most common motor contraction pattern was peristaltic. The percentage of peristaltic activity per subject was significantly higher in group 1 (p < 0.05). There were no significant differences in other contraction patterns among the three groups (p > 0.05). Of the peristaltic contraction wave characteristics there were no significant differences in any parameters (amplitude, duration, and velocity) among the three groups (p > 0.05). The average pH increment in response to motor activities was significantly higher in group 1 (p < 0.05). CONCLUSIONS: Motor responses to GOR were found to be predominantly primary peristaltic in all groups. During GOR, reflux patients have less frequent activity, a smaller proportion of activity is peristaltic, and the average pH increment in response to motor activities is reduced compared with controls.

Transition from nutcracker esophagus to achalasia.

Nutcracker esophagus is essentially a manometric diagnosis characterized by high-amplitude, often prolonged duration of peristaltic contractions in the distal two thirds of the esophagus. Its association with noncardiac chest pain and/or dysphagia has been recognized and reported by numerous esophageal motility laboratories. There are very few long-term studies of the natural history of this abnormality. We report a patient who presented with dysphagia and, on initial investigation, was found to have classical nutcracker esophagus. On reinvestigation three years later, however, he had developed achalasia of the cardia. The transition from nutcracker esophagus to achalasia has not previously been reported.

Cortical bone grafts with muscle pedicles. An experimental study of survival and ability to bridge a bone gap.

A cortical bone graft on a muscle pedicle was taken from the ulna and transferred to bridge a complete defect of the radius in 16 dogs. In 14 control dogs a free graft was used, that is, one without a muscle pedicle. Union in the group with pedicle grafts was far superior to that in the group with free grafts, mainly because in those with pedicle grafts there was good subperiosteal new bone formation from active viable periosteum. In six of the pedicle grafts the viability of some osteocytes was retained over a 12-week period and in five the graft was almost completely replaced by new bone.