Effect of swallowed bolus viscosity and body position on esophageal transit, contraction and perception of transit.

BACKGROUND: The esophagus has a different response in relation to the characteristics of a swallowed bolus. Bolus viscosity and body position may affect esophageal contraction and transit. Objectives To investigate the effect of bolus viscosity and body position on esophageal contraction, transit and perception. METHODS: Esophageal contraction, transit and perception of transit were evaluated in 26 asymptomatic volunteers, 13 men and 13 women aged 18-60 years, mean: 33.6 (12.2) years. Esophageal contraction (manometry) and transit (impedance) were measured with a solid state catheter with sensors located 5, 10, 15, and 20 cm from the lower esophageal sphincter. Each volunteer swallowed in duplicate and in random sequence a 5 mL low viscous (LV) liquid bolus of an isotonic drink with pH 3.3, and a 5 mL high viscous (HV) paste bolus, which was prepared with 7.5 g of instant food thickener diluted in 50 mL of water (pH: 6.4). RESULTS: Total bolus transit time, in the sitting position, was longer with the HV bolus than with the LV bolus. Esophageal transit was longer in the supine position than in the sitting position. Bolus head advance time was longer with the HV bolus than with the LV bolus in both positions. Contraction esophageal amplitude was higher in the supine position than in the sitting position. The perception of bolus transit was more frequent with the HV bolus than with the LV bolus, without differences related to position. CONCLUSIONS: The viscosity of the swallowed bolus and body position during swallows has an influence on esophageal contractions, transit and perception of transit.

Effect of swallwwed bolus viscosity and body poition on esophageal transit, coontraction and perception of transit / Efeito da viscosidade do bolo e da posição corporal no trânsito, contrações do esôfago e na percepção do trânsito

Background The esophagus has a different response in relation to the characteristics of a swallowed bolus. Bolus viscosity and body position may affect esophageal contraction and transit. Objectives To investigate the effect of bolus viscosity and body position on esophageal contraction, transit and perception. Methods Esophageal contraction, transit and perception of transit were evaluated in 26 asymptomatic volunteers, 13 men and 13 women aged 18-60 years, mean: 33.6 (12.2) years. Esophageal contraction (manometry) and transit (impedance) were measured with a solid state catheter with sensors located 5, 10, 15, and 20 cm from the lower esophageal sphincter. Each volunteer swallowed in duplicate and in random sequence a 5 mL low viscous (LV) liquid bolus of an isotonic drink with pH 3.3, and a 5 mL high viscous (HV) paste bolus, which was prepared with 7.5 g of instant food thickener diluted in 50 mL of water (pH: 6.4). Results Total bolus transit time, in the sitting position, was longer with the HV bolus than with the LV bolus. Esophageal transit was longer in the supine position than in the sitting position. Bolus head advance time was longer with the HV bolus than with the LV bolus in both positions. Contraction esophageal amplitude was higher in the supine position than in the sitting position. The perception of bolus transit was more frequent with the HV bolus than with the LV bolus, without differences related to position. Conclusions The viscosity of the swallowed bolus and body position during swallows has an influence on esophageal contractions, transit and perception of transit. .

Contexto O esôfago tem resposta diferente relacionada às características do bolo deglutido. A viscosidade do bolo e a posição corporal podem afetar a contração do esôfago e o trânsito. Objetivos Investigar o efeito da viscosidade do bolo e da posição corporal sobre a contração do esôfago e no trânsito. Métodos A contração do esôfago, o trânsito e a percepção do trânsito foram avaliadas em 26 voluntários assintomáticos, 13 homens e 13 mulheres com idade entre 18 e 60 anos, média: 33,6 (12,2) anos. A contração do esôfago (manometria) e trânsito (impedância) foram medidas com um cateter de estado sólido com sensores localizados a 5, 10, 15 e 20 cm do esfíncter esofágico inferior. Cada voluntário deglutiu, em duplicata, 5 mL de bolo líquido (baixa viscosidade - BV, pH: 3,3) e 5 mL de bolo pastoso (alta viscosidade - AV, pH: 6,4). Resultados O tempo de trânsito total do bolo, na posição sentada, foi mais longo com o bolo AV do que com bolo BV. O trânsito pelo esôfago foi mais longo na posição supina do que na posição sentada. O tempo de avanço da cabeça do bolo foi mais longo com bolo AV do que com bolo BV, em ambas as posições. A amplitude da contração do esôfago foi maior na posição supina do que na posição sentada. A percepção do trânsito do bolo foi mais frequente com o bolo AV do que com o bolo BV, sem diferença relacionada com a posição. Conclusões A viscosidade do bolo deglutido e a posição do corpo durante a deglutição têm influência sobre as contrações esofágicas e no trânsito pelo esôfago. .

Esophageal Transit, Contraction and Perception of Transit After Swallows of Two Viscous Boluses.

BACKGROUND: There have been results showing the influence of bolus viscosities and consistency on esophageal motility and transit. However, there is no description about the influence of two different viscous boluses on esophageal contractions, bolus transit and perception of transit. Our objective in this investigation was to evaluate the esophageal transit and contraction after swallows of two viscous boluses. METHODS: By impedance and manometric methods, we measured the esophageal transit and contraction after swallows of two viscous boluses of 5 mL volume, 100% barium sulfate and yogurt, swallowed in duplicate in the supine and upright positions. The bolus transit, esophageal contractions and the perception of bolus transit through the esophagus were evaluated in both positions. Impedance and contraction were measured at 5, 10, 15 and 20 cm from the lower esophageal sphincter. After each swallow, the volunteers were asked about the sensation of bolus transit through the esophagus. RESULTS: In supine position, the yogurt had a less frequent complete bolus transit than barium. Also in the supine position, the esophageal transit was longer with yogurt than with barium. Esophageal contractions after swallows were similar between barium and yogurt boluses. There was no difference in perception of transit between the two boluses. CONCLUSION: Although both 100% barium sulfate and yogurt are viscous boluses and have similar viscosities, the transit through the esophagus is slower with yogurt bolus than with barium bolus, which suggests that viscosity may be not the sole factor to determine transit.

Esophageal contractions, bolus transit and perception of transit after swallows of liquid and solid boluses in normal subjects / Contrações esofágicas, trânsito do bolo e percepção do trânsito após deglutições de bolos líquido e sólido em voluntários normais

CONTEXT: Esophageal dysphagia is the sensation that the ingested material has a slow transit or blockage in its normal passage to the stomach. It is not always associated with motility or transit alterations. OBJECTIVES: To evaluate in normal volunteers the possibility of perception of bolus transit through the esophagus after swallows of liquid and solid boluses, the differences in esophageal contraction and transit with these boluses, and the association of transit perception with alteration of esophageal contraction and/or transit. METHODS: The investigation included 11 asymptomatic volunteers, 4 men and 7 women aged 19-58 years. The subjects were evaluated in the sitting position. They performed swallows of the same volume of liquid (isotonic drink) and solid (macaroni) boluses in a random order and in duplicate. After each swallow they were asked about the sensation of bolus passage through the esophagus. Contractions and transit were evaluated simultaneously by solid state manometry and impedance. RESULTS: Perception of bolus transit occurred only with the solid bolus. The amplitude and area under the curve of contractions were higher with swallows of the solid bolus than with swallows of the liquid bolus. The difference was more evident in swallows with no perception of transit (n = 12) than in swallows with perception (n = 10). The total bolus transit time was longer for the solid bolus than for the liquid bolus only with swallows followed by no perception of transit. CONCLUSION: The results suggest that the perception of esophageal transit may be the consequence of inadequate adaptation of esophageal transit and contraction to the characteristics of the swallowed bolus.

CONTEXTO: Disfagia esofágica é a sensação de que o alimento ingerido tem trânsito lento ou é bloqueado em sua passagem para o estômago. Nem sempre o sintoma é associado com alterações em trânsito ou motilidade. OBJETIVOS: Avaliar, em voluntários normais, a possibilidade de percepção do trânsito através do esôfago de bolo sólido e líquido, as diferenças nas contrações esofágicas e no trânsito pelo esôfago com estes bolos, e a associação entre percepção do trânsito com alterações nas contrações e/ou trânsito. MÉTODOS: Foram estudados 11 voluntários assintomáticos, 4 homens e 7 mulheres com idades entre 19 e 58 anos. Os voluntários foram avaliados na posição sentada. Eles deglutiram, em duplicata, o mesmo volume de bolo sólido (macarrão) e líquido (bebida isotônica). Após cada deglutição foi perguntado sobre sensação da passagem do bolo pelo esôfago. Contrações e trânsito foram avaliados simultaneamente por manometria de estado sólido e impedância. RESULTADOS: Percepção do trânsito ocorreu apenas com o bolo sólido. A amplitude e área sob a curva das contrações foram maiores com a deglutição do bolo sólido do que com a deglutição de bolo líquido. A diferença foi mais evidente nas deglutições em que não houve percepção do trânsito (n = 12) do que nas deglutições com percepção (n = 10). O tempo total de trânsito foi mais longo para o bolo sólido do que para o bolo líquido somente com as deglutições seguidas pela não percepção do trânsito. CONCLUSÃO: Os resultados sugerem que a percepção da passagem do bolo pelo esôfago deve estar relacionada à adaptação inadequada das contrações esofágicas e do trânsito às características do bolo deglutido.

Esophageal contractions, bolus transit and perception of transit after swallows of liquid and solid boluses in normal subjects.

CONTEXT: Esophageal dysphagia is the sensation that the ingested material has a slow transit or blockage in its normal passage to the stomach. It is not always associated with motility or transit alterations. OBJECTIVES: To evaluate in normal volunteers the possibility of perception of bolus transit through the esophagus after swallows of liquid and solid boluses, the differences in esophageal contraction and transit with these boluses, and the association of transit perception with alteration of esophageal contraction and/or transit. METHODS: The investigation included 11 asymptomatic volunteers, 4 men and 7 women aged 19-58 years. The subjects were evaluated in the sitting position. They performed swallows of the same volume of liquid (isotonic drink) and solid (macaroni) boluses in a random order and in duplicate. After each swallow they were asked about the sensation of bolus passage through the esophagus. Contractions and transit were evaluated simultaneously by solid state manometry and impedance. RESULTS: Perception of bolus transit occurred only with the solid bolus. The amplitude and area under the curve of contractions were higher with swallows of the solid bolus than with swallows of the liquid bolus. The difference was more evident in swallows with no perception of transit (n = 12) than in swallows with perception (n = 10). The total bolus transit time was longer for the solid bolus than for the liquid bolus only with swallows followed by no perception of transit. CONCLUSION: The results suggest that the perception of esophageal transit may be the consequence of inadequate adaptation of esophageal transit and contraction to the characteristics of the swallowed bolus.

Effect of age on proximal esophageal response to swallowing / Influência da idade na resposta do esôfago proximal à deglutição

CONTEXT: It has been demonstrated that the ageing process affects esophageal motility. OBJECTIVES: To evaluate the effect of the age on the proximal esophageal response to wet swallows. METHOD: We measured the proximal esophageal response to swallows of a 5 mL bolus of water in 69 healthy volunteers, 20 of them aged 18-30 years (group I), 27 aged 31-50 years (group II), and 22 aged 51-74 years (group III). We used the manometric method with continuous perfusion. The proximal esophageal contractions were recorded 5 cm from a pharyngeal recording site located 1 cm above the upper esophageal sphincter. The time between the onset of the pharyngeal and of the proximal esophageal recording (pharyngeal-esophageal time) and the amplitude, duration and area under the curve of the proximal esophageal contraction were measured. RESULTS: The pharyngeal-esophageal time was shorter in group I subjects than in group II and III subjects (P<0.05). The duration of proximal esophageal contractions was longer in group I than in groups II and III (P<0.001). There was no differences between groups in the amplitude or area under the curve of contractions. There were no differences between groups II and III for any of the measurements. CONCLUSION: We conclude that the age may affects the response of the proximal esophagus to wet swallows.

CONTEXTO: O processo natural de envelhecimento altera a motilidade do esôfago. OBJETIVO: Estudar o efeito da idade na resposta da parte proximal do esôfago à deglutição de água. MÉTODO: Mediu-se a resposta do esôfago proximal à deglutição de 5 mL de água em 69 voluntários saudáveis, 20 com idades de 18 a 30 anos (grupo I), 27 com idades de 31 a 50 anos (grupo II) e 22 com idades de 51 a 74 anos (grupo III). Utilizamos o método manométrico com perfusão contínua. As contrações do esôfago proximal foram medidas 5 cm distal a um registro das contrações em faringe, localizado 1 cm acima do esfíncter superior do esôfago. Foram medidos o tempo entre o início da contração em faringe e o início da contração em esôfago proximal (tempo faringoesofágico), e a amplitude, duração e área sob a curva da contração proximal. RESULTADOS: O tempo faringoesofágico teve menor duração nos sujeitos do grupo I do que naqueles dos grupos II e III (P<0,05). A duração da contração em esôfago proximal foi maior nos sujeitos do grupo I do que naqueles dos grupos II e III (P<0,001). Não houve diferenças entre os grupos na amplitude e na área sob a curva das contrações, e não houve diferenças entre os grupos II e III em todas as medidas. CONCLUSÃO: Observou-se que a idade pode alterar a resposta do esôfago proximal à deglutição de água.

Contrações esofágicas proximais e distais no esôfago em quebra-nozes / Proximal and distal esophageal contractions in nutcracker esophagus

JUSTIFICATIVA E OBJETIVOS: Esôfago em quebra-nozes é diagnosticado quando as contrações peristálticas na parte distal do esôfago têm amplitude acima de 180 mmHg, o que pode causar sintomas, mas também pode ocorrer em pessoas assintomáticas. O objetivo deste estudo foi avaliar a amplitude e a duração da contração esofágica em todo segmento do esôfago onde há predominância de musculatura lisa, comparando o resultado de pacientes com esôfago em quebra-nozes com pessoas com motilidade do esôfago normal. MÉTODO: Com o método manométrico e perfusão contínua estudaram-se as contrações esofágicas a 2, 7, 12 e 17 cm do esfíncter inferior do esôfago em 16 sujeitos (média de idade: 46,7 anos) com amplitude de contração acima de 180 mmHg no registro de motilidade a 2 cm e/ou 7 cm proximal ao esfíncter inferior do esôfago (quebra-nozes), e em 27 sujeitos (média de idade: 38,5 anos) com amplitude de contração, medidas nos mesmos locais, entre 30 e 180 mmHg (controles). Cada sujeito realizou 10 deglutições de 5 mL de água. RESULTADOS: Em todos os locais a amplitude, duração e área sob a curva das contrações foram maiores nos sujeitos com esôfago em quebra-nozes do que nos controles (p < 0,01). O tempo de propagação das contrações peristálticas foi similar entre os dois grupos (p > 0,10). CONCLUSÃO: O aumento da amplitude e duração das contrações esofágicas observadas na parte distal do esôfago do paciente com esôfago em quebra-nozes está presente em todo esôfago onde há predominância da musculatura lisa.

BACKGROUND AND OBJECTIVES: Nutcracker esophagus is a condition seen in subjects with peristaltic distal esophageal contractions amplitude above 180 mmHg. It may be associated with symptoms, but may be found in asymptomatic subjects. Our aim in this investigation was to measure the amplitude and duration of the peristaltic esophageal contraction where the esophagus is composed by smooth muscle, comparing the results of patients with nutcracker esophagus with that of subjects with normal esophageal motility. METHOD: With the manometric method and continuous perfusion we measured the esophageal contractions at 2, 7, 12 and 17 cm from the lower esophageal sphincter in 16 subjects (mean age: 46.7 years) with amplitude of contractions above 180 mmHg at 2 and/or 7 cm from the lower esophageal sphincter (nutcracker), and in 27 subjects (mean age: 38.5 years) with amplitude of contractions from 30 to 180 mmHg at 2 and 7 cm from the lower esophageal sphincter (controls). Each subject performed 10 swallows of a 5 mL bolus of water. RESULTS: In every place where the esophageal motility was measured the amplitude, duration and area under the curve of contractions were higher in subjects with nutcracker esophagus than in controls (p < 0.01). The time between the upstroke of esophageal contractions measured each 5 cm was similar in the two groups (p > 0.10). CONCLUSION: The increase in amplitude and duration of esophageal contraction observed in distal esophageal body of subjects with nutcracker esophagus is seen in all esophageal body where there is smooth muscle.

Otimização da dose em exames de rotina em tomografia computadorizada: estudo de viabilidade em um Hospital Universitário / Radiation dose optimization in routine computed tomography: a study of feasibility in a University Hospital

OBJETIVO: Estudar a viabilidade de redução da dose de radiação em protocolos de aquisição de imagens de tomografia helicoidal em um hospital universitário. MATERIAIS E MÉTODOS: Foi realizado levantamento de dose de radiação de protocolos de tomografia com objetos simuladores e câmara de ionização. Foram propostas variações de kVp e mAs, determinando-se a média de ruído. Protocolos com valores de ruído menores ou iguais a 1 por cento foram submetidos à avaliação qualitativa de contraste e resolução espacial por três observadores. RESULTADOS: Foram realizados 22 testes de variações para o protocolo de crânio pediátrico, 26 para crânio adulto, 28 para abdome e 18 para tórax. A redução da dose conseguida variou entre 7,4-13 por cento para protocolo de crânio pediátrico, 3,8-25 por cento para crânio adulto, 9,6-34,3 por cento para abdome e 6,4-12 por cento para tórax. Notou-se também que a utilização de ferramentas de janelamento e zoom favoreceu o aceite das imagens pelos observadores. CONCLUSÃO: É possível reduzir os níveis de dose de radiação em até 34,4 por cento, comparativamente aos protocolos utilizados na rotina, mantendo-se o ruído em níveis aceitáveis. O uso de ferramentas de manipulação digital das imagens possibilitou a aceitação de imagens com níveis maiores de ruído, favorecendo o processo de redução de dose de radiação.

OBJECTIVE: To study the feasibility of reducing radiation dose in protocols for acquisition of helical computed tomography images in a University Hospital. MATERIALS AND METHODS: A survey of radiation doses in computed tomography protocols was performed with phantoms and ionization chamber. Changes in kVp and mAs were proposed, determining the average noise. Protocols with noise values 1 percent were submitted to qualitative assessment of contrast and spatial resolution by three observers. RESULTS: Tests of variations were performed with 22 protocols for pediatric skulls, 26 for adult skulls, 28 for abdomen, and 18 for chest. The reduction in dose achieved ranged between 7.4 percent and13 percent for pediatric skull, 3.8 percent and 25 percent for adult skull, 9.6 percent and 34.3 percent for abdomen, 6.4 percent and 12 percent for chest. It was also noted that the use of windowing and zoom tools supported the acceptance of images by the observers. CONCLUSION: Radiation dose levels can be reduced by up to 34.4 percent in comparison with routine protocols, keeping the noise at acceptable levels. The use of digital manipulation tools allowed the acceptance of images with higher noise levels, thus resulting in radiation dose reduction.

Effect of age on proximal esophageal response to swallowing.

CONTEXT: It has been demonstrated that the ageing process affects esophageal motility. OBJECTIVES: To evaluate the effect of the age on the proximal esophageal response to wet swallows. METHOD: We measured the proximal esophageal response to swallows of a 5 mL bolus of water in 69 healthy volunteers, 20 of them aged 18-30 years (group I), 27 aged 31-50 years (group II), and 22 aged 51-74 years (group III). We used the manometric method with continuous perfusion. The proximal esophageal contractions were recorded 5 cm from a pharyngeal recording site located 1 cm above the upper esophageal sphincter. The time between the onset of the pharyngeal and of the proximal esophageal recording (pharyngeal-esophageal time) and the amplitude, duration and area under the curve of the proximal esophageal contraction were measured. RESULTS: The pharyngeal-esophageal time was shorter in group I subjects than in group II and III subjects (P<0.05). The duration of proximal esophageal contractions was longer in group I than in groups II and III (P<0.001). There was no differences between groups in the amplitude or area under the curve of contractions. There were no differences between groups II and III for any of the measurements. CONCLUSION: We conclude that the age may affects the response of the proximal esophagus to wet swallows.

Esophageal Contractions After Wet and Dry Swallows in Patients With Esophagitis, Chagas' Disease and Idiopathic Achalasia.

BACKGROUND: In normal subjects the distal esophageal response to dry swallows differs from that of wet swallows. Our aim in this investigation was to compare the esophageal contractions of the proximal and distal esophageal body to wet and dry swallows. METHODS: We studied the esophageal contractions of eight patients with idiopathic achalasia, 37 patients with Chagas' disease, 28 patients with esophagitis, and 31 normal volunteers using manometric examination with continuous perfusion. The esophageal contractions were measured at 2 cm (proximal) and 22 cm (distal) from the upper esophageal sphincter. Five swallows of a 5 ml bolus of water alternated with 5 dry swallows were performed. RESULTS: In the proximal esophagus there was no difference between wet and dry swallows. In patients with esophagitis and volunteers the contractions in the distal esophagus had greater amplitude with wet swallows than with dry swallows. Contraction amplitude was lower than the amplitude of the other groups, in both the proximal and distal esophageal body in achalasia, and in distal esophageal body in Chagas' disease. The interval between the upstroke of contractions in the proximal and distal esophageal body was longer in volunteers and patients with esophagitis than in patients with Chagas' disease and achalasia. CONCLUSIONS: Wet swallows cause higher amplitude of contraction in distal esophagus than dry swallows, which is not seen in diseases with impairment of esophageal innervation (achalasia and Chagas' disease). In the proximal esophagus there is no difference in contractions caused by wet or dry swallows.