Browsing by Author "Abrahao Jr, Luiz"

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    Breaks in peristaltic integrity predict abnormal esophageal bolus clearance better than contraction vigor or residual pressure at the esophagogastric junction
    (2021) Rogers, Benjamin D.; Cisternas, Daniel; Rengarajan, Arvind; Marin, Ingrid; Abrahao Jr, Luiz; Hani,Albis; Lequizamo, Ana M.; Remes-Troche, José M.; Perez de la Serna, Julio; Ruiz de Leon, Antonio; Zerbib, Frank; Serra, Jordi; Gyawali, C. Prakash
    Background: High- resolution impedance manometry (HRIM) evaluates esophagealperistalsis and bolus transit. We used esophageal impedance integral (EII), the ratio between bolus presence before and after an expected peristaltic wave, to evaluate predictors of bolus transit. Methods: From HRIM studies performed on 61 healthy volunteers (median age 27 years, 48%F), standard metrics were extracted from each of 10 supine water swallows: distal contractile integral (DCI, mmHg cm s), integrated relaxation pressure(IRP, mmHg), and breaks in peristaltic integrity (cm, using 20 mmHg isobaric contour). Pressure and impedance coordinates for each swallow were exported into a dedi -cated, python- based program for EII calculation (EII ratio ≥ 0.3 = abnormal bolus clear -ance). Univariate and multivariate analyses were performed to assess predictors of abnormal bolus clearance. Key Results: Of 591 swallows, 80.9% were intact, 10.5% were weak, and 8.6% failed. Visual analysis overestimated abnormal bolus clearance compared to EII ratio (p ≤ 0.01). Bolus clearance was complete (median EII ratio 0.0, IQR 0– 0.12) in 82.0% of intact swallows in contrast to 53.3% of weak swallows (EII ratio 0.29, IQR 0.0– 0.57), and 19.6% of failed swallows (EII ratio 0.5, IQR 0.34– 0.73, p < 0.001). EII correlated best with break length (ρ = 0.52, p < 0.001), compared to IRP (ρ: −0.17) or DCI (ρ: −0.42). On ROC analysis, breaks predicted abnormal bolus transit better than DCI or IRP (AUC 0.79 vs. 0.25 vs. 0.44, p ≤ 0.03 for each). On logistic regression, breaks remained independently predictive of abnormal bolus transit (p < 0.001). Conclusions & Inferences: Breaks in peristaltic integrity predict abnormal bolus clear-ance better than DCI or IRP in healthy asymptomatic subjects.
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    Ineffective esophageal motility and bolus clearance. A study with combined high-resolution manometry and impedance in asymptomatic controls and patients
    (2020) Zerbib, Frank; Marin, Ingrid; Cisternas, Daniel; Abrahao Jr, Luiz; Hani, Albis; Leguizamo, Ana M.; Remes-Troche, José M.; Perez de la Serna, Julio; Ruiz de Leon, Antonio; Serra, Jordi
    Background The definition and relevance of ineffective esophageal motility (IEM) remains debated. Our aim was to determine motility patterns and symptoms associated with IEM defined as impaired bolus clearance. Methods To define altered bolus clearance, normal range of swallows with complete bolus transit (CBT) on high-resolution impedance manometry (HRIM) was determined in 44 asymptomatic controls. The results were then applied to a cohort of 81 patients with esophageal symptoms to determine the motility patterns which best predicted altered bolus clearance. Subsequently, in a cohort of 281 consecutive patients the identified motility patterns were compared with patients’ customary symptoms. Key Results In asymptomatic controls, the normal range of swallows with CBT was 50%-100%. In patients, altered bolus transit (<50% CBT) was only associated with 30% or more failed contractions (P < .001). Neither weak peristalsis nor absence of contraction reserve (CR) was associated with altered bolus clearance. The patterns which best predicted altered bolus clearance were failed contractions ≥30% (specificity 88.2% and sensitivity of 84.6%), and ≥70% ineffective (failed + weak) contractions (sensitivity 84.6% and specificity 80.9%). No motility pattern was correlated to symptom scores. Conclusions and Inferences Based on bolus clearance assessed by HRIM, ≥30% failed contractions and ≥70% ineffective contractions have the best sensitivity and specificity to predict altered bolus clearance. Weak contractions and absence of CR are not relevant with respect to bolus clearance.

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