| Part I Influence of the catheter diameter on the investigation of the esophageal motility through solid state high resolution manometryBackground and aims:High resolution manometry (HRM) is gradually widely used in the esophageal motility research. Besides the commonly used catheters, small diameter catheter for adult use was produced to achieve more comfort and better performance in the situations of narrow passway of esophageal manometry. There was no research to evaluate whether catheters of different diameter could provide similar data and results.Methods:Nine asymptomatic volunteers and 9 gastroesophageal reflux disease (GERD) patients accepted HRM examinations with 4.2mm and 2.7mm thick solid state catheters. Every HRM examination contained 5 min resting pressure,10 water swallows and 10 bread swallows. Some important parameters of the esophageal sphinters and esophageal body peristalsis were analyzed. For example the locations and resting pressure of sphincters, the distal contractile integral (DCI), the 4s integrated relaxation pressure (4s IRP) etc.Then these parameters and the diagnosis of each swallow based on them provided by the two different diameter catheters were compared.Results:(1) The 4.2 mm thick catheter provided higher upper esophageal sphincter (UES) resting pressure than the 2.7mm thick catheter; (2) the 2.7mm thick catheter provided higher 4s IRP than the 4.2mm thick catheter; (3) the mean DCI of the water swallows in the large diameter catheter was higher than in the small diameter catheter; (4) the 4.2mm thick catheter detected more aperistalsis swallows than the 2.7mm thick catheter in water swallows, and the 2.7mm thick catheter detected more hypotensive peristalsis swallows than the other catheter in water swallows;(5) There were some differences of the final motility assessment and diagnosis with the 4.2mm thick catheter and 2,7mm thick catheter.Conclusions:The 2.7mm thick catheter provides somewhat different data from the usually used 4.2mm thick HRM catheter. For the small diameter catheter, a new series of normative value is needed to set up for its further utilization in the research and clinic. PartⅡThe motility of esophagogastric junction under high resolution esophageal manometry in 110 Chinese asymptomatic volunteersBackground and aims:High resolution esophageal manometry was introduced to China for about 3 to 4 years, and many clinical motility centers have the expierence of using this technique. It is lack of normative values of the Chinese high reslution esophageal manomery parameters, and the aim of this study was to set up the normative value database of the high resolution manometry in Chinese asymtomatic volunteers.Methods:110 asymtomatic volunteers from different areas of China accepted high resolution esophageal manometry in 11 gastrointestinal motility centers at different hospitals. Parameters of the esophagogastric junctions including morphologic parameters (the position of the LES midpoint, upper and lower margin of the LES and pressure inverion point; the length of the esophagus, LES and intra-abdomal LES), LES resting pressure parameters (LES respiratory minimal pressrue and LES respiratory average pressure) and LES relaxation parameters (4s integrated relaxation pressure and intrabolus pressure) were analyzed. Then they were compared with the cutoff in foreign criterion especially the Chicago classification.Results:(1)Seven subjects were excluded finally and 103 subjects were left. There were totally 1017 water swallows and 874 solid swallows were analyzed. (2) All parameters were expressed as [mean±sd, P95]. The position of those EGJ anatomy structures were the depth relative to the nose. The position of the LES midpoint, upper and lower margin of the esophagogastric junction and the pressure inversion point were [43.8±3.1,48.5] cm, [42.4±3.1,47.5]cm, [46.0±2.9,51.0]cm and [43.4±3.1,48.4]cm respectively;The length of the esophagus, LES and intraabdominal LES were [25.0±2.1,29.0]cm,[3.7±0.8,5.3]cm and [2.7±0.6,3.9]cm.(3) The LES respiratory minimal pressure was[12.4±6.1,23.8] mmHg and the LES respiratory average pressure was[20.8±7.1,34.1]mmHg;(4)For water swallows the 4s IRP was [10.5±4.5,18.8] mmHg and the IBP was[10.3±4.7,17.8] mmHg; For solid swallows, the 4s IRP was[10.5±4.3,18.9] mmHg and the IBP was[13.1±5.0,21.4] mmHg.The 4s IRP between water swallows and solid swallows wasn't different (p=0.955), but the IBP of solid swallows was higher than the water swallows(p=0.000).Conclusions:The normative values for most EGJ pressure parameters was higher than them of the foreign standards. PartⅢThe manomatric Characteristics of hypotensive swallows under high resolution impedance manometryBackground and aims:The diagnostic criterion for hypotensive swallow was changed from≥3cm defect in 30mmHg isobaric contour to≥2cm defect in 20mmHg isobaric contour. Sometimes, for one swallow, it could be diagnosed differently using different standards. High resolution impedance manometry has the ability to do manometry and reflect the results of bolus clearance simultaneously, and it is a relativley objective tool to diagnose hypotensive swallow which is with incomplete bolus clearence. The aim of this study was to observe the manometric features of the hypotensive swallows with high resolution impedance manometry.Methods:The manometric data of 5 asymptomatic volunteers and 15 gastroesophageal reflux disease patients were analyzed. Each swallow was classified as normal swallow (complete bolus clearance) and hypotensive swallow (incomplete bolus clearance), and then its peristaltic topography was analyzed with the 20mmHg and 30mmHg isobaric contour to know the information of the defects.Results:(1) There were 200 water swallows from the 20 subjects. Ten aperistalsis swallows were excluded and 190 water swallows were left for the final analysis. (2)For the 190 water swallows,88.4% of them was diagnosed correctly using the 20mmHg isobaric contour defect standard and 87.9% of them was diagnosed the same as the impedance with the 30mmHg isobaric contour defect standard. The correct diagnosis rate of both isobaric contour defect criteria wasn't different (p=0.874). (3) For those swallows with complete bolus clearance, the maximal defect of 20mmHg and 30mmHg isobaric contour defect were 5.3cm and 15.2cm respectively; For those incomplete bolus clearance swallows the minimal defect of the two isobaric contour were 0.8cm and 1.2cm; (4) For the complete bolus clearance swallows,12 of them was misdiagnosed as hypotensive swallows with the 20mmHg or 30mmHg isobaric contour defect cutoff. The exact value of these defects in 20mmHg isobaric contour were relatively closed and they were smaller than 5cm, while the exact value of the defects in 30mmHg isobaric contour were relatively dispersed. The maximum and minimum were 15.2 cm and 3.1 cm. (5) In those incomplete bolus clearance swallows,23 of them was misdiagnosed as normal swallows with both isobaric contour defect criteria. Although these defects were small, they led to incomplete bolus clearance. 91.3% of these defects were located most distally of the esophageal body. (6) For the distance between the proximal skeletal muscle contraction and the middle and distal smooth muscle contraction, in the complete bolus clearance swallows, the maximum of the 20mmHg and 30mmHg isobaric contour were 4.4cm and 9.5cm. In incomplete bolus clearance swallows, the minimum of the 20mmHg and 30mmHg isobaric contour were 1.1cm and 4.5cm.Conclusions:(1) Defect of the isobaric contour as a standard to diagnose hypotensive swallow isn't reasonable, and the high resolution impedance manometry is the optimal tool for the evaluation of the esophgeal motility. (2) The 20mmHg isobaric contour defect criterion is relatively stable compared with the 30mmHg isobaric contour defect criterion. Defect over 5 cm of the 20mmHg isobaric contour always predicts incomplete bolus clearance. The results of the bolus clearance of the swallows whose defects are less than 5cm are variable. (3) Defects located at the most distal part of the esophageal body always lead to failed bolus clearance even though the defect is quite small. (4) If the lower margin of the transition zone wasn't clear, the method which was reported as setting 2cm as the TZ length to determine the defect of the isobaric contour in distal esophagus isn't acceptable.
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