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High Resolution Manometry Evaluation of the Motility of the Pharyngo-Upper Esophageal Area in Patients With Achalasia.
Mariano D. Menezes*1, Fernando a. Herbella1, Marco G. Patti2
1Gastroenterology Surgery, Unifesp, Londrina, Brazil; 2Surgery, University Chicago, Chicago, IL
Introduction. The motility of the pharynx, upper esophageal sphincter (UES), and proximal esophagus is still poorly understood. These structures have anatomical and functional peculiarities that hinder the accurate study of their motility with conventional manometry. High resolution manometry (HRM) seems to be an adequate tool for the evaluation of this area even though the experience with this technology is still incipient. It is unclear, in patients with achalasia, if the motility of this area may be compromised. This study aims to evaluate the motility of the pharynx, UES, and proximal esophagus.
Methods. 60 patients with achalasia underwent HRM (52% females, mean age 54). Esophageal dilatation was classified according to the radiologic diameter in type I (<4cm): 6%; Type II (4-7cm): 36%; Type III (7-10cm): 34%; and Type IV (>10cm): 24%. HRM classified 43% of the patients as Chicago Type I and 57% as Type II. Manometric parameters were compared to normal values obtained from a previous study in volunteers.
Results. Manometric parameters are depicted in table 1. Velumpharynx showed short, premature and hypertonic contraction. Epiglotis showed hypertonic contraction. UES showed increase residual pressure. The proximal esophagus showed worse distally (4-6 cm) in amplitude and duration contraction wave. Chicago Type II patients had higher UES residual pressure (p=0.03). The degree of esophageal dilatation did not correlate with manometric parameters.
Conclusions. Achalasia may affect the motility of the pharyngo-upper esophageal area. The changes observed may represent functional alterations to prevent aspiration, especially in patients with Chicago Type II achalasia that may denote an esophagus replenished with fluids.
Data are presented as median, range and percentage of patients with acalasia with abnormal parameter of high resolution manometry.
| Velumpharynx | Epiglottis | Upper Esophageal Sphincter | Proximal Esophagus | Upstroke (mmHg/s) 971,55
621,7 - 351,7
66% abnormal | Peak Pressure
(ms) 154,1
118,5 195,7
75% abnormal | Residual Pressure
(mmHg) 9,3
7 - 14,7
75% abnormal | Wave Amplitude 4 cm UES
(mmHg) 30,8
26,7 - 37
82% abnormal | Contraction Duration (ms) 408,5
315,2 -523,7
78% abnormal | Upstroke
(mmHG/s) 1000,7
672 - 1475,4
53% abnormal | | Wave Amplitude 6 cm UES
(mmHg) 23,6
19,9 - 29,3
85% abnormal | UES relaxation latency (ms) -296,5
-441 to -132,5
90% abnormal | | | Wave Duration 2cm UES
(ms) 5,6
3,4 - 7,9
91% abnormal | UES maximum relaxation latency (ms) -127
-285,2 - 33,2
90% abnormal | | | Wave Duration 4cm UES
(ms) 5,4
3,2 - 8,2
87% abnormal | UES end relaxation latency (ms) 466,5
291,7 - 604,2
80% abnormal | | | Wave Duration 6cm UES
(ms) 5,3
3,4 - 8,2
87% abnormal |
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