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Anatomo-Physiology of the Pharyngo-Upper Esophageal Area in Volunteers At the Light of High Resolution Manometry: Defining Normal Values
Luciana C. Silva*1, Fernando a. Herbella1, Luciano R. Neves1, Fernando P. Vicentine1, SebastiãO Pannocchia1, Marco G. Patti2
1UNIFESP, Sao Paulo, Brazil; 2Department of Surgery, University of Chicago, Chicago, IL

Introduction: High resolution manometry (HRM) is a recent and valuable tool in the assessment of esophageal motility. The experience with this technology in the evaluation of pharyngeal and upper esophageal disorders is still incipient. This study aims to: (a) define normal values for pharyngo-upper esophageal motility, and (b) correlate HRM plots with pharyngeal anatomic landmarks.
Methods: 29 healthy individuals (mean age 30 years, 62% males) underwent HRM with a solid-state catheter with 36 circumferential sensors spaced 1 cm apart positioned to record from the base of the tongue to the esophagus. Pharyngeal, upper esophageal sphincter and proximal esophagus parameters were recorded by giving 10 swallows of 5 mL of water at 30-second intervals. The analysis was performed with the commercial dedicated software. Fourteen individuals also underwent a concomitant transnasal pharyngoscopy.
Results: Manometric parameters are depicted in table 1. The correlation between HRM plots and pharyngeal anatomic landmarks is shown in figure 1.
Conclusion: Normal values for pharyngeal, upper esophageal sphincter and proximal esophagus parameters have been determined. These results may be applied in future studies.

Manometric values
Pharynx Upper esophageal sphincter Proximal esophagus
Peak pressure at 2 cm above mid UES 203,8 (160-225,6) Basal pressure 88,5 (65,72-119,55) Amplitude 2 cm below mid UES 64,3 (51,7-100,4)
Contraction duration at 2 cm above mid UES 471 (349-697) Residual pressure 4,1 (0,85-7,77) Amplitude 4 cm below mid UES 65,7 (45,7-76,5)
Start at 2 cm above mid UES to UES start -494 (-541- -419) Relaxation time to nadir 198 (169,7-264) Amplitude 6 cm below mid UES 35,05 (18,8-47,3)
Start at 2 cm above mid UES to UES nadir -235 (-355 - -181) Ralaxation duration 698,5 (629,7-773,2)
Start at 2 cm above mid UES to UES end 212 (183-269) Recovery duration 475 (380,2-561,5)

Data presented as median (interquartile range)


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