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Permanent URL to this publication: http://dx.doi.org/10.5167/uzh-10787

Ghosh, S K; Janiak, P; Fox, M; Schwizer, W; Hebbard, G S; Brasseur, J G (2008). Physiology of the oesophageal transition zone in the presence of chronic bolus retention: studies using concurrent high resolution manometry and digital fluoroscopy. Neurogastroenterology and Motility, 20(7):750-759.

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Abstract

Distinct contraction waves (CWs) exist above and below the transition zone (TZ) between the striated and smooth muscle oesophagus. We hypothesize that bolus transport is impaired in patients with abnormal spatio-temporal coordination and/or contractile pressure in the TZ. Concurrent high resolution manometry and digital fluoroscopy were performed in healthy subjects and patients with reflux oesophagitis; a condition associated with ineffective oesophageal contractility and clearance. A detailed analysis of space-time variations in bolus movement, intra-bolus and intra-luminal pressure was performed on 17 normal studies and nine studies in oesophagitis patients with impaired bolus transit using an interactive computer based system. Compared with normal controls, oesophagitis patients had greater spatial separation between the upper and lower CW tails [median 5.2 cm (range 4.4-5.6) vs 3.1 cm (2.2-3.7)], the average relative pressure within the TZ region (TZ strength) was lower [30.8 mmHg (28.3-36.5) vs 45.8 mmHg (36.1-55.7), P < 0.001], and the risk of bolus retention was higher (90%vs 12%; P < 0.01). The presence of bolus retention was associated with a wider spatial separation of the upper and lower CWs (>3 cm, the upper limit of normal; P < 0.002), independent of the presence of oesophagitis. We conclude that bolus retention in the TZ is associated with excessively wide spatial separation between the upper and lower CWs and lower TZ muscle squeeze. These findings provide a physio-mechanical basis for the occurrence of bolus retention at the level of the aortic arch, and may underlie impaired clearance with reflux oesophagitis.

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Gastroenterology and Hepatology
DDC:610 Medicine & health
Language:English
Date:July 2008
Deposited On:20 Jan 2009 11:12
Last Modified:27 Nov 2013 21:21
Publisher:Wiley-Blackwell
ISSN:1350-1925
Additional Information:The definitive version is available at www.blackwell-synergy.com
Publisher DOI:10.1111/j.1365-2982.2008.01129.x
PubMed ID:18422907
Citations:Web of Science®. Times Cited: 21
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Scopus®. Citation Count: 26

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