Effect of Different Swallow Time Intervals on The Nutcracker Esophagus

Nutcracker esophagus (NE) is defined as the presence of peristaltic contractions in which the average distal esophageal amplitude is greater than 180 mm Hg. The underlying mechanism responsible for these abnormalities is not known. The aim of this study was to test the hypothesis that NE might be ca...

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Veröffentlicht in:The American journal of gastroenterology 2003-01, Vol.98 (1), p.40-45
Hauptverfasser: Brito, Eliza Maria, Camacho-Lobato, Luciana, Paoletti, Vera, Gideon, Mathew, Katz, Philip O, Castell, Donald O
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container_start_page 40
container_title The American journal of gastroenterology
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creator Brito, Eliza Maria
Camacho-Lobato, Luciana
Paoletti, Vera
Gideon, Mathew
Katz, Philip O
Castell, Donald O
description Nutcracker esophagus (NE) is defined as the presence of peristaltic contractions in which the average distal esophageal amplitude is greater than 180 mm Hg. The underlying mechanism responsible for these abnormalities is not known. The aim of this study was to test the hypothesis that NE might be caused by a defect in the inhibitory pathway controlling esophageal peristalsis. Eight patients with NE (seven women, 1 man, mean age 50 yr) and eight age- and sex-matched normal volunteers (seven women, 1 man, mean age 48 yr) underwent a special protocol using three-channel (3, 8, and 16 cm above the lower esophageal sphincter) solid state esophageal manometry to evaluate deglutitive inhibition. Ten pairs of 5 ml of wet swallows were given at each of five different time intervals (30, 20, 15, 10, and 5 s). Pairs of swallows were spaced by 30 s, and different time intervals were spaced by 1 min. Tracings were recorded using a computer program and blindly automatically analyzed for both amplitude and duration of the contraction separately for the first and second swallow of each pair. Presence of deglutitive inhibition or muscle refractoriness was assessed according to interactions between the first and second swallow of the pair. Results were found abnormal when larger than the mean percent variation of the second and first swallow calculated for the 30-s interval, considered as baseline for each participant. Statistics included paired and nonpaired nonparametrical comparisons as appropriate. The median amplitude for the NE was 202 mm Hg (range 186–376) and for the controls was 118 mm Hg (range 64–167) (P = 0.0002). The median duration in the NE group was 5.1 s (range 4–9.3) versus 4.1 (range 3.3–5.0) for the controls (P = 0.02). The percent variation in duration (P = 0.31), amplitude (P = 0.42), and propagation velocity of the peristaltic waves (P = 0.69) did not differ between the control and NE groups. Peristalsis frequency dropped at the 5-s interval for both studied groups (P = 0.84). Central and local inhibitory mechanisms induced by closely timed swallows are preserved in the NE and do not explain the mechanism of the high amplitude and long duration contractions.
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The underlying mechanism responsible for these abnormalities is not known. The aim of this study was to test the hypothesis that NE might be caused by a defect in the inhibitory pathway controlling esophageal peristalsis. Eight patients with NE (seven women, 1 man, mean age 50 yr) and eight age- and sex-matched normal volunteers (seven women, 1 man, mean age 48 yr) underwent a special protocol using three-channel (3, 8, and 16 cm above the lower esophageal sphincter) solid state esophageal manometry to evaluate deglutitive inhibition. Ten pairs of 5 ml of wet swallows were given at each of five different time intervals (30, 20, 15, 10, and 5 s). Pairs of swallows were spaced by 30 s, and different time intervals were spaced by 1 min. Tracings were recorded using a computer program and blindly automatically analyzed for both amplitude and duration of the contraction separately for the first and second swallow of each pair. Presence of deglutitive inhibition or muscle refractoriness was assessed according to interactions between the first and second swallow of the pair. Results were found abnormal when larger than the mean percent variation of the second and first swallow calculated for the 30-s interval, considered as baseline for each participant. Statistics included paired and nonpaired nonparametrical comparisons as appropriate. The median amplitude for the NE was 202 mm Hg (range 186–376) and for the controls was 118 mm Hg (range 64–167) (P = 0.0002). The median duration in the NE group was 5.1 s (range 4–9.3) versus 4.1 (range 3.3–5.0) for the controls (P = 0.02). The percent variation in duration (P = 0.31), amplitude (P = 0.42), and propagation velocity of the peristaltic waves (P = 0.69) did not differ between the control and NE groups. Peristalsis frequency dropped at the 5-s interval for both studied groups (P = 0.84). 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The underlying mechanism responsible for these abnormalities is not known. The aim of this study was to test the hypothesis that NE might be caused by a defect in the inhibitory pathway controlling esophageal peristalsis. Eight patients with NE (seven women, 1 man, mean age 50 yr) and eight age- and sex-matched normal volunteers (seven women, 1 man, mean age 48 yr) underwent a special protocol using three-channel (3, 8, and 16 cm above the lower esophageal sphincter) solid state esophageal manometry to evaluate deglutitive inhibition. Ten pairs of 5 ml of wet swallows were given at each of five different time intervals (30, 20, 15, 10, and 5 s). Pairs of swallows were spaced by 30 s, and different time intervals were spaced by 1 min. Tracings were recorded using a computer program and blindly automatically analyzed for both amplitude and duration of the contraction separately for the first and second swallow of each pair. Presence of deglutitive inhibition or muscle refractoriness was assessed according to interactions between the first and second swallow of the pair. Results were found abnormal when larger than the mean percent variation of the second and first swallow calculated for the 30-s interval, considered as baseline for each participant. Statistics included paired and nonpaired nonparametrical comparisons as appropriate. The median amplitude for the NE was 202 mm Hg (range 186–376) and for the controls was 118 mm Hg (range 64–167) (P = 0.0002). The median duration in the NE group was 5.1 s (range 4–9.3) versus 4.1 (range 3.3–5.0) for the controls (P = 0.02). The percent variation in duration (P = 0.31), amplitude (P = 0.42), and propagation velocity of the peristaltic waves (P = 0.69) did not differ between the control and NE groups. Peristalsis frequency dropped at the 5-s interval for both studied groups (P = 0.84). Central and local inhibitory mechanisms induced by closely timed swallows are preserved in the NE and do not explain the mechanism of the high amplitude and long duration contractions.</abstract><cop>Oxford</cop><pub>.</pub><pmid>12526934</pmid><doi>10.1111/j.1572-0241.2003.07181.x</doi><tpages>6</tpages></addata></record>
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subjects Adult
Aged
Biological and medical sciences
Deglutition
Digestive system
Esophageal Motility Disorders - physiopathology
Esophagus
Female
Gastroenterology
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Investigative techniques, diagnostic techniques (general aspects)
Male
Manometry
Medical sciences
Middle Aged
Other diseases. Semiology
Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques
Peristalsis
Time Factors
title Effect of Different Swallow Time Intervals on The Nutcracker Esophagus
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