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Distal contractile integral measurement and vascular compression in the esophagus: a problem unsolved?
- Source :
-
Esophagus : official journal of the Japan Esophageal Society [Esophagus] 2020 Oct; Vol. 17 (4), pp. 502-507. Date of Electronic Publication: 2020 Apr 30. - Publication Year :
- 2020
-
Abstract
- Background: Distal contractile integral (DCI) is influenced by factors other than esophageal smooth muscle contractility, such as intrabolus pressure and vascular and respiratory movements' artifacts. We aimed to determine the size of the contribution of pressures generated by vascular compression on the esophagus to the DCI measured in HRM recordings in symptomatic patients.<br />Methods: HRM manometry recordings obtained from 383 subjects referred to the GI motility laboratory at a tertiary center (2012-2016) were evaluated by visual inspection for evidence of strong vascular compression (SVC) of the esophagus. Clinical, demographic, manometric, and serologic data for Chagas disease were obtained. Subjects were classified, respectively, as asymptomatics (ASYM) or symptomatics (SYMP). DCI and SVC-DCI were measured, and the SVC-DCI/DCI ratio was expressed as a percentage and the difference between DCI and SVC-DCI (neat-DCI) was calculated. DCI, SVC-DCI, SVC-DCI/DCI % and neat-DCI from SYMP and ASYM were compared.<br />Results: SVC was conspicuous in 42 of 383 subjects (11%). In 33 subjects, SVC was detected only in supine position. SVC was localized in middle esophagus in 21 subjects (50%), in distal esophagus in 12 subjects (29%) and in both regions in 9 subjects (21%). In 9 subjects, SVC vanished from the swallowing window analysis (21%).<br />Conclusions: SVC is a common finding in esophageal HRM study, particularly in the supine position. Occasionally, its contribution to DCI value is sufficiently great to masquerade esophageal hypocontractility. Different manometric protocols may be required in patients with SVC.
- Subjects :
- Adult
Artifacts
Case-Control Studies
Chagas Disease blood
Chagas Disease diagnosis
Chagas Disease epidemiology
Deglutition physiology
Esophageal Motility Disorders diagnosis
Esophagus physiology
Female
Humans
Male
Middle Aged
Muscle, Smooth physiology
Peristalsis physiology
Pressure adverse effects
Prevalence
Chagas Disease physiopathology
Esophageal Motility Disorders physiopathology
Esophagus blood supply
Manometry methods
Muscle Contraction physiology
Subjects
Details
- Language :
- English
- ISSN :
- 1612-9067
- Volume :
- 17
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Esophagus : official journal of the Japan Esophageal Society
- Publication Type :
- Academic Journal
- Accession number :
- 32356213
- Full Text :
- https://doi.org/10.1007/s10388-020-00740-x