Biomedical subjects

R Matthew Gideon

Publications and source records attributed to R Matthew Gideon.

4 recordsLinked to original sources

PubMed2005

Manometry: technical issues.

Manometry involves many technical issues, and a complete understanding of all aspects of the esophageal testing process is required to study the human esophagus in a way that yields accurate, technically sound qualitative and quantitative studies that include the measure of esophageal length and positional plotting of transducers within the esophagus. Topics discussed are catheter measurement and memory; checking the system; performing manometry; patient history; intubation technique; marking, mapping, and measuring the esophagus, and analysis of results.

Catheterization↗

PubMed2003

Are manometric parameters of the upper esophageal sphincter and pharynx affected by age and gender?

The effects of age and gender on the upper esophageal sphincter's (UES) and pharyngeal manometric parameters were investigated in 84 healthy subjects (45 men, 39 women, mean age = 44 years, range = 18-91). Manometric recordings were performed with solid-state circumferential transducers. Subjects older than 60 years (n = 23) showed a significant lower UES resting pressure. In addition, during water swallows they had a higher UES residual pressure, shorter UES relaxation interval and UES relaxation duration, and a decreased UES relaxation rate. Furthermore, pharyngeal contraction had significant higher amplitude and longer duration in subjects older than 60 years during water swallows. Some of these findings were also observed during cookie and pudding swallows. Women had a higher UES resting pressure and a longer UES relaxation interval than men. The observed changes with increasing age indicate loss of basal tone and decreased compliance of the UES. Increased pharyngeal contraction amplitude and its prolonged duration in the elderly might be compensatory to this. These physiologic effects of age and gender on UES and pharyngeal parameters should be taken into account during analysis of manometric studies.

Adolescent↗

PubMed2003

Diffuse esophageal spasm: not diffuse but distal esophageal spasm (DES).

Diffuse esophageal spasm is an uncommon motility disorder that is found in less than 5% of patients undergoing esophageal motility testing for dysphagia. It is defined manometrically by the presence of 20% or more simultaneous contractions in the distal esophageal body with normal peristalsis. This motility abnormality has been traditionally identified as occurring primarily in the smooth muscle portion of the distal esophagus yet, the term "diffuse" persists in the medical literature to identify DES. The aim of our study was to assess the diffuse or limited nature of this entity by evaluating the prevalence of simultaneous contractions in both proximal and distal esophagus in patients with DES. We reviewed esophageal motility tracings of 53 consecutive patients (32 F, 21 M) with DES and compared them with 53 age-matched patients with manometric normal studies. In the distal esophagus we found 195 simultaneous contractions (37% of swallows) with a median of 3 and range of 2-7 per patient. Of the 53 patients with DES a total of 13 simultaneous contractions (2% of swallows) occurred in the proximal esophagus with only 3 (5.6%) of the 53 patients having 2 or more simultaneous contractions in 10 swallows. None of the patients with normal manometry showed more than one simultaneous contraction in either proximal or distal esophagus. In conclusion, these findings suggest that the term diffuse esophageal spasm is a misnomer and the DES is more appropriately described as "distal" esophageal spasm.

Adult↗

PubMed2003

Effects of position on oesophageal function: studies using combined manometry and multichannel intraluminal impedance.

Multichannel intraluminal impedance (MII) allows assessment of intraoesophageal bolus transit. In the supine position, bolus transit is produced almost exclusively by peristaltic contractions; in the upright position, gravity also contributes to bolus transit. MII and peristaltic pressures were measured in four positions (0, 30, 60 and 90 degrees ) using ten swallows (5 cc each) of both water and viscous liquid with body position determined by random choice. Tracings were analysed for total bolus transit time: time interval between bolus entry at 20 cm above and bolus exit at 5 cm above the lower oesophageal sphincter (LOS) and contraction amplitudes at 5 and 10 cm above the LOS. Statistical comparison of mean values of all four body positions was done using anova and Bonnferoni post-test. Ten normal subjects (five females and five males, age 24-45 years) completed the study. At each body position, liquid material transited faster (P < 0.001) than viscous material. Both liquid and viscous materials transited at lower inclinations (0 and 30 degrees ) significantly slower than at higher inclinations (60 and 90 degrees ). There was an almost perfect inverse linear correlation between angle of inclination and bolus transit time for both liquid (r = -0.99) and viscous (r = -1.00) boluses (Spearman correlation r > 0.99 and P < 0.02 for both substances). Contraction amplitudes for liquid vs viscous material were not significantly different at a given degree of inclination. Mean distal oesophageal amplitude declined with increasing inclination. Combined MII-OM identifies and quantifies the effects of gravity on the dichotomy between specific pressures measured by OM and function assessed as transit measured by MII.

Adult↗