Normative Values for Esophageal Motility Assessed in the Physiological Seated Position for 16-Channel Water Perfused High-resolution Esophageal Manometry System and Postural Variations in Healthy Volunteers

Background/Aims@#Consensus guidelines for performance and analysis of high-resolution esophageal manometry (HREM) recommend use of equipment, population and posture specific normative values. To provide normative values for Chicago classification (CC) metrics in the physiological seated position for a 16-channel water perfused system (Dentsleeve HREM catheter, Advanced Manometry Systems, Melbourne, Australia) widely used in India and other countries with limited access to solid-state equipment. The results are compared with published CC metrics in supine position done using the same system and volunteers. @*Methods@#HREM tracings of ten 5 mL water swallows in sitting posture were acquired in healthy volunteers and normative values for CC version 3.0 metrics calculated. Individual swallows were paired with previously reported supine swallows for postural variations (Wilcoxon sign rank test) and concordance of CC diagnoses (Pearson coefficient). @*Results@#Analysis of 530 sitting posture water swallows (53 subjects) and comparison with their supine data revealed significantly higher integrated relaxation pressure (IRP; median 6.7 mmHg vs 6.1 mmHg) but lower distal latency (DL; mean 6.3 seconds vs 6.8 seconds) and distal contractile integral (DCI; mean 1224 mmHg∙sec∙cm vs 1456 mmHg∙sec∙cm). Sitting posture normal was defined as: IRP 4.5, and DCI = 115-4500 (absent contractility: DCI < 30). CC diagnoses concordance using posture-specific cut-offs was moderate (k = 0.47). @*Conclusions@#This paper provides normative values for the Advanced Manometry Systems 16-channel water perfused system in the physiological seated position for CC metrics. Our findings of higher IRP and lower DCI in sitting posture than previously reported supine CC cut-offs, confirm the need to use posture-specific cut-offs for reporting HREM tracings.

An Interesting Case of Post-fundoplication Dysphagia

No abstract available.

Hypertensive Peristalsis: A Rare Cause of Dysphagia in a Child

No abstract available.

The Comprehensive Muscular Activity Profile (CMAP): its high sensitivity, specificity and overall classification rate for detecting submaximal effort on functional capacity testing.

INTRODUCTION: A traditional problem faced by clinicians attempting to objectively measure musculoskeletal disorders such as low back pain, where there is often primarily soft tissue involvement, is that psychosocial factors (e.g., fear-avoidance, secondary gain) frequently influence the experience/reporting of pain. Nevertheless, there is still a great need for the quantification of physical function, with appropriate criteria in place, in order to help assess both physical impairment and therapeutic endpoint following treatment. One such potentially objective measure is surface electromyographic (sEMG) recordings during purposeful muscular activity and resting states. The present randomized controlled study assessed the potential validity of a new sEMG approach-the comprehensive muscular activity profile (CMAP)-by addressing the following question: can the CMAP accurately document whether a subject is exerting appropriate muscular effort during range-of-motion and lifting testing, or is submaximum effort being exerted? METHODS: Eighty healthy volunteers were randomly assigned to either: (1) an instruction group encouraging maximum effort on the tests; or (2) an instruction group encouraging "faking" and not putting in maximum effort on the tests. Therapists, who then administered the CMAP protocol (range-of-motion and lifting tests), were kept blind to subject group assignment. They were also asked to complete a rating scale evaluating whether subjects were exerting maximum effort after all the tests were completed. RESULTS: In differentiating between the two instruction groups, the CMAP demonstrated high levels of sensitivity [predicting maximum effort on all tests (ranging from 84.6 to 94.9%)]. In contrast, the sensitivity of the therapists' ratings was much lower (ranging from only 72.5 to 80.0%). Most importantly, when the CMAP data and therapists' ratings were combined, logistic regression analyses revealed high rates of sensitivity (94.4-97.2%), specificity (84.6-92.3%), and overall classification (90.7-93.3%). CONCLUSION: The results of this study demonstrate the potential utility of the CMAP, combined with therapist ratings, as a valid method of objectively quantifying subject muscular performance and effort during lumbar range-of-motion and lifting tasks.