High Resolution Impedance Manometry (HRiM ) Swallow Atlas

Transcription

1 High Resolution Impedance Manometry (HRiM ) Swallow Atlas

2 Normal Esophageal Function Bolus Transit UES Esophageal Body LES Complete bolus transit Peristaltic contractions with pressure amplitude of at least 30mmHg Normal LES pressure Complete LES relaxation (< 8mm Hg) Complete bolus transit Peristaltic contractions with a contiguous 20mmHg isobaric contour, no large or small breaks Normal LES resting pressure IRP < 15mmHg

3 Achalasia Type I Incomplete Bolus Transit Absent Peristalsis (Req d) Low Esophageal Amplitude May have High LES Pressure and/or Incomplete Relaxation Incomplete bolus transit Aperistaltic Low esophageal amplitude Typically high LES pressure 100% failed peristalsis

4 Achalasia Type II Incomplete Bolus Transit Absent Peristalsis (Required), Panesophageal Pressurization May have High LES Pressure and/or Incomplete Relaxation Incomplete bolus transit Aperistaltic Panesophageal pressurization Typically high LES pressure No normal peristalsis Panesophageal pressurization with 20% of swallows

5 Achalasia Type III Incomplete Bolus Transit Absent Peristalsis (Required), Increased Esophageal Amplitude May have High LES Pressure and/or Incomplete Relaxation Incomplete bolus transit Aperistaltic Esophageal amplitude > 50mmHg Typically high LES pressure No normal peristalsis Preserved fragments of distal peristalsis or premature (spastic) contraction with 20% of swallows

6 Hypertensive Disorders: Nutcracker, Jackhammer Complete Bolus Transit High Esophageal Body Amplitude Incomplete LES Relaxation Complete bolus transit Normal peristalsis High esophageal amplitude (may have prolonged duration), average DEA 220mmHg Normal or high LES pressure Complete or incomplete LES relaxation Nutcracker: Mean DCI > 5,000mmHg-s-cm, but not meeting criteria for Jachkhammer esophagus Jackhammer: At least one swallow with a DCI > 8,000mmHg-s-cm with single peaked or multipeaked contraction

7 Weak/Ineffective Esophageal Motility (IEM) Incomplete Bolus Transit Low or Nontransmitted Esophageal Body Contractions Complete LES Relaxation Complete or incomplete bolus transit Peristaltic or simultaneous contractions Low or nontransmitted esophageal contractions (30mmHg), with 5 or more swallows Normal or low LES pressure Complete LES relaxation 5 or more swallows with any combination of failed peristalsis or weak contraction with large or small break or with a DCI < 450mmHg-s-cm. Small Peristaltic Breaks 2-5cm in length Large Peristaltic Breaks > 5cm in length Complete LES relaxation

8 Distal Esophageal Spasm (DES) Incomplete Bolus Transit Simultaneous, Repetitive Contractions Complete LES Relaxation 20% premature, repetitive (> 2 peaks) contractions Complete or incomplete bolus transit Prolonged duration (> 6 secs) Intermittent normal peristalsis High amplitude not common 20% premature contractions Normal IRP

9 Scleroderma Incomplete Bolus Transit Normal Upper Esophageal Body Amplitude Weak to Absent Lower Esophageal Body Amplitude Incomplete bolus transit Weak to absent lower esophageal contraction (smooth muscle) Normal upper esophageal amplitude (striated muscle) Low to absent LES pressure (< 10mmHg) Chicago Classification Not described in the literature on Chicago Classifications

10 Hiatal Hernia Incomplete Bolus Transit Normal Esophageal Body Amplitude Double High Pressure Zone Complete or incomplete bolus transit Double high pressure zone May have normal LES pressure and relaxation May have short esophageal length Chicago Classification Not described in the literature on Chicago Classifications

11 * Chicago classification criteria of esophageal motility disorders defined in high resolution pressure topography; Brenenoord, et.al, Neurogastric & Motility, January 2012; 24 Suppl 1:57-65 Sandhill Scientific, Inc 9150 Commerce Center Circle, #500 Highlands Ranch, CO USA Fax: COPYRIGHT 2013 SANDHILL SCIENTIFIC PRINTED IN THE U.S.A. PL Rev. 1.0