Ambulatory high-resolution manometry, lower esophageal sphincter lift and transient lower esophageal sphincter relaxation
Article first published online: 10 NOV 2011
© 2011 Blackwell Publishing Ltd
Neurogastroenterology & Motility
Volume 24, Issue 1, pages 40–e2, January 2012
How to Cite
Mittal, R. K., Karstens, A., Leslie, E., Babaei, A. and Bhargava, V. (2012), Ambulatory high-resolution manometry, lower esophageal sphincter lift and transient lower esophageal sphincter relaxation. Neurogastroenterology & Motility, 24: 40–e2. doi: 10.1111/j.1365-2982.2011.01816.x
- Issue published online: 21 DEC 2011
- Article first published online: 10 NOV 2011
- Received: 5 July 2011 Accepted for publication: 23 September 2011
- longitudinal muscle contraction;
- mechanosensitive motor neurons
Background Lower esophageal sphincter (LES) lift seen on high-resolution manometry (HRM) is a possible surrogate marker of the longitudinal muscle contraction of the esophagus. Recent studies suggest that longitudinal muscle contraction of the esophagus induces LES relaxation.
Aim Our goal was to determine: (i) the feasibility of prolonged ambulatory HRM and (ii) to detect LES lift with LES relaxation using ambulatory HRM color isobaric contour plots.
Methods In vitro validation studies were performed to determine the accuracy of HRM technique in detecting axial movement of the LES. Eight healthy normal volunteers were studied using a custom designed HRM catheter and a 16 channel data recorder, in the ambulatory setting of subject’s home environment. Color HRM plots were analyzed to determine the LES lift during swallow-induced LES relaxation as well as during complete and incomplete transient LES relaxations (TLESR).
Key Results Satisfactory recordings were obtained for 16 h in all subjects. LES lift was small (2 mm) in association with swallow-induced LES relaxation. LES lift could not be measured during complete TLESR as the LES is not identified on the HRM color isobaric contour plot once it is fully relaxed. On the other hand, LES lift, mean 8.4 ± 0.6 mm, range: 4–18 mm was seen with incomplete TLESRs (n = 80).
Conclusions & Inferences Our study demonstrates the feasibility of prolonged ambulatory HRM recordings. Similar to a complete TLESR, longitudinal muscle contraction of the distal esophagus occurs during incomplete TLESRs, which can be detected by the HRM. Using prolonged ambulatory HRM, future studies may investigate the temporal correlation between abnormal longitudinal muscle contraction and esophageal symptoms.