Sleep GERD

10% 11% 10%
LESR duration {s) tOP.loP 2oP.2oP
8.6+/-0,8"* 9.7+/-1,0'* 5,2*/-0.5 5.4+/-0.6 6.5+/0.7 5.1+/-0.5
S1725
Impact of Severity and Bolus Consistency on Esophageal Clearance by Hypotensive Peristalsis Determined by Multiple Intraluminal Impedance (MII) Nam Q. Nguyen, Rachael Rigda, Marcus Tippett, Richard H. Holloway
88% O* 78% 68% O* 59% 4% 0 0 *: p<O.05vs I~176 & vs 2"P-I~ **: vs Long.
Intervals Short Medium Loeg
inhibitionof peristalsis (%) loP-loP loP-2oP 2Cp-loP racteristics of Primary and Secondary Esophageal Peristalsis during Maturation in Human Neonates Sudarshan R. Jadcherla, Reza Shaker
BACKGROUND AND AIMS: Esophageal defensive motor responses facilitate luminal clearance and protect the aerodigestive tract. As known from adult studies, esophageal motility responses may be due to swallow-mediated Primary Peristalsis (PP) or esophageal distention mediated Secondary Peristalsis (SP). However, similar information in developing infants is lacking, and comparison of quantitative characteristics of PP and SP in developing premature infants are not known. METHODS: We studied esophageal motility responses during basal state and upon abrupt mid-esophageal provocation using air or liquids in 16 prematurely born (26.0 to 33.7 wks gestation) infants at 33.1 +- 1.5 (study-I) and 35.6 _+1.7 wks (study2) postmenstrual age (P < 0.05). Using a specially designed esophageal manometry catheter and a minimally compliant pneumohydraufic perfusion system and a Grass recording system, we measured esophageal body characteristics during alert and active state. PP was defined as spontaneous swallow mediated fully propagated esophageal peristalsis. SP was defined as esophageal peristalsis upon mid esophageal provocation with air or liquids, and in the absence of a swallow. Alert active state was determined by direct observation, video recording, submental EMG recording, and respiratory pattern. Statistical comparison was done by paired t test. RESULTS: A total of 116 and 122 PP sequences, and 18 and 27 SP sequences at study-1 and study-2 respectively were evaluated. Specifically, proximal and distal esophageal amplitude and duration, and propagating velocity during PP and SP are similar at either time points in maturation.(see table below) CONCLUSIONS: Esophageal body characteristics of PP and SP during alert active states are similarly matured as early as and beyond 33 weeks postmenstrual age.
Propagated pressure waves <30mmHg but > 10mmHg in the distal esophagus are defined as hypotensive. Radiological and scintigraphic studies suggest that these waves are associated with impaired clearance. However, these studies have only been performed with liquid boluses and their effectiveness with vkseous boluses and impact of the extent of the manometric abnormality has not been reported. Aims. To assess esophageal clearance of liquid and viscous boluses by hypotensive pressure waves using MII. Methods. Concurrent perfusion manometry and MII was performed in 25 healthy volunteers (16M, 9F, 20-77 years). Esophageal motility was measured at 4 sites, 2, 7, 12,17cm above the LES. MII was measured at corresponding sites with electrodes incorporated into the assembly. Ten, 5-ml liquid (saline) boluses and 10, 5-ml low-impedance viscous boluses were tested in each subject. Normal values for segmental clearance at each site (bolus presence time (BPT)) and from the whole esophagus (total bolus transit time (TBTT)) were derived from normal peristaltic responses (distal esophageal wave amplitude > 35mmHg). The proportion of normal BPT and TBTT was determined for all peristaltic responses that contained at least one hypotensive pressure wave. The impact of the number of hypotensive pressure waves in each sequence was aIso assessed Results. Segmental clearance (BPT) of liquids was normal at all sites in 89%, and TBTT normal in 95%, of responses with hypotensive pressure waves. Prolonged BPT and TBTT were significantly more frequent with increasing extent of hypotensive pressure waves (Table). Hypotensive responses were less likely to clear the viscous bolus than the liquid bolus from individual segments (Table) and the esophagus as a whole. (normal TBTT 67% vs 86%, p<0.O01). Conclusions. Uni-focal hypotensive peristalsis does not substantially impair esophageal clearance of either liquid and viscous boluses. Impaired clearance becomes more likely the more hypotensive segments are present. However, even when hypotensive pressure waves are present at all sites, the majority of liquid boluses are cleared normally. Viscous boluses are less well cleared than liquid boluses.