By Jeffrey Conklin MD (auth.), Edy Soffer, Mark Pimentel, Jeffrey Conklin (eds.)
While reflux ailment, achalasia, esophageal spasm, gastroparesis and IBS comprise probably the most universal problems in all ailment different types, our knowing in their pathophysiology is still elusive. the sphere of medical gastrointestinal motility has for many years depended on the dimension of intraluminal pressures to infer intestinal activities that outline those tough and enigmatic issues of intestine functionality. even supposing pcs have significantly facilitated the research of knowledge received from intraluminal strain recordings, the sensors and catheters used to degree intraluminal pressures have replaced little over the past 20 years.
In the final three years, a brand new technologic leap forward has taken position within the assessment of gastrointestinal motor functionality. it's known as high-resolution manometry. instead of the previous four to eight channel traditional structures used to degree intraluminal strain, high-resolution catheters hire 36 heavily spaced, reliable nation strain transducers. This expertise complements the answer of intestine motor job tremendously. through the use of colour to depict strain, high-resolution colour contours are appealing pictures that supply a close spatial and temporal photograph of gastrointestinal motor functionality that was once formerly very unlikely. via spotting motor styles, diagnoses should be made which are very tough, if now not very unlikely, to understand with the outdated know-how. High-resolution manometry is a dramatic technical bounce in many years stagnant field.
Jeffrey Conklin, MD, is scientific Director, Esophageal middle at Cedars-Sinai clinical heart, la, California.
Mark Pimentel, MD, is Director, GI Motility application, Cedars-Sinai scientific heart, la, California.
Edy Soffer, MD, is Co-Director, GI Motility software, Cedars-Sinai scientific heart, la, California.
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Extra resources for Color Atlas of High Resolution Manometry
This indicates that the bolus was not cleared from the esophagus. 2. Abnormal High-Resolution Esophageal Manometry A 200 WS 39 WS 16 UES 50 18 30 50 34 50 38 Cm from Nares Pressure (mmHg) 100 50 43 LES 50 10 sec 48 0 B 15 mmHg 20 140 120 25 30 80 60 35 40 30 20 40 Cm from Nares 100 45 0 10 sec 50 Fig. 24. Ineffective esophageal motility. (A) A recording of two WSs displayed to simulate a conventional manometric tracing. There is peristalsis in the smooth muscle esophagus, but its amplitude appears low.
The resting LES pressure is normal, but it is not clear whether LES relaxation is appropriate. (B) The HRM color contour provides more information regarding this motor event. The WS initiates peristalsis in the striated muscle esophagus (*), but no peristaltic activity is generated in the smooth muscle segment. Several seconds later another peristaltic sequence occurs in the striated muscle, but it is not preceded by swallowing. It is, however, followed by normal peristalsis in the smooth muscle esophagus.
Resting LES pressure is normal and the LES relaxation is present. mmHg 15 WS UES 20 UES 140 120 25 30 80 60 35 40 LES 40 20 0 Cm from Nares 100 45 10 sec 50 Fig. 29. Failure of striated muscle function: radiation injury. This HRM color contour was recorded from a patient with dysphagia and cough who received radiation to the neck as treatment for laryngeal cancer. WS indicates the timing of a wet swallow. Resting UES pressure is very low, and there is essentially no motor activity in the pharynx or striated muscle esophagus.