Document Detail


The effect of a sitting vs supine posture on normative esophageal pressure topography metrics and Chicago Classification diagnosis of esophageal motility disorders.
MedLine Citation:
PMID:  22897486     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although, the current protocol for high resolution manometry (HRM) using the Chicago Classification is based on the supine posture, some practitioners prefer a sitting posture. Our aims were to establish normative esophageal pressure topography data for the sitting position and to determine the effect of applying those norms to Chicago Classification diagnoses.
METHODS: Esophageal pressure topography studies including test swallows in both a supine and sitting position of 75 healthy volunteers and 120 patients were reviewed. Integrated relaxation pressure (IRP), distal contractile integral (DCI), contractile front velocity (CFV), and distal latency were measured and compared between postures. Normative ranges were established from the healthy volunteers and the effect of applying sitting normative values to the patients was analyzed.
KEY RESULTS: Normative values of IRP, DCI, and CFV all decreased significantly in the sitting posture. Applying normative sitting metrics to patient studies [27% reduction in IRP (15 to 11 mmHg), 69% reduction in DCI (8000-2500 mmHg-s-cm)] reclassified 13/120 (11%) patients as having abnormal esophagogastric junction relaxation and 26/120 (22%) as hypercontractile. Three patients with an abnormal supine IRP normalized when sitting with elimination of a vascular artifact.
CONCLUSIONS & INFERENCES: Clinical HRM studies should include both a supine and sitting position to minimize misdiagnoses attributable to anatomical factors. However, until outcome studies demonstrating the significance of isolated abnormalities of IRP or DCI in the sitting position are available, the Chicago Classification of esophageal motility disorders should continue to be based on supine swallows using normative data from the supine posture.
Authors:
Y Xiao; A Read; F Nicodème; S Roman; P J Kahrilas; J E Pandolfino
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-08-16
Journal Detail:
Title:  Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society     Volume:  24     ISSN:  1365-2982     ISO Abbreviation:  Neurogastroenterol. Motil.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-09-12     Completed Date:  2013-06-04     Revised Date:  2013-10-17    
Medline Journal Info:
Nlm Unique ID:  9432572     Medline TA:  Neurogastroenterol Motil     Country:  England    
Other Details:
Languages:  eng     Pagination:  e509-16     Citation Subset:  IM    
Copyright Information:
© 2012 Blackwell Publishing Ltd.
Affiliation:
Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, IL 60611-2951, USA. yinglian.xiao@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Esophageal Motility Disorders / classification,  diagnosis*
Female
Humans
Male
Manometry / methods*,  standards*
Middle Aged
Posture*
Young Adult
Grant Support
ID/Acronym/Agency:
R01 DK056033/DK/NIDDK NIH HHS; R01 DK079902/DK/NIDDK NIH HHS; R01 DK079902/DK/NIDDK NIH HHS; R01 DK56033/DK/NIDDK NIH HHS
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