Abstract
A two-channel 24-hr digital recording of esophageal pressure generates about 20 times more data than an esophageal pH-metry if an appropriate high sampling rate is used and unreduced data are stored. Because of this large amount of data, manual data evaluation is no longer feasible, and a computer-assisted procedure becomes necessary. The system presented here consists of a combined one-channel pH and two-channel pressure probe, a digital data logger, and a computer program for automated evaluation (CAMA). From the pH channel, standard variables (acid exposure time and number of reflux episodes) are calculated. The analysis of the pressure channels is completed in five distinct steps: (1) recognition of contractory events using dynamically recalculated baseline and threshold values, (2) characterization of contractory events, (3) rejection of artifacts, (4) classification of contractions, and (5) integrated analysis (frequency analysis, hourly patterns of single variables, relation to other external variables). This system has been used successfully more than 150 times in more than 120 patients and volunteers; validation was done for contraction characterization by comparing the system's performance with manual analysis and for contraction detection and classification by comparing its performance with a reference standard established from a questionnaire evaluated by international experts. In addition, the reproducibility of esophageal motility has been tested in a series of repeated measurements, and the system has been used to assess the 24-hr pattern of esophageal motility.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Branicki FJ, Evans DF, Ogilvie AL, Atkinson M, Hardcastle JD: Ambulatory monitoring of oesophageal pH in reflux oesophagitis using a portable radiotelemetry system. Gut 23:992–998, 1982
Emde C, Garner A, Blum AL: Technical aspects of intraluminal pH-metry in man: Current status and recommendations. Gut 28:1177–1188, 1987
Castell JA, Richter JE, Castell DO: Comparison of effect of decreasing sampling rates on measurement of esophageal peristaltic amplitudes and durations. Gastroenterology 95:859, 1988 (abstract)
Emde C, Armstrong D, Bumm R, Kaufhold H-J, Riecken EO, Blum AL: Twenty-four-hour continuous ambulatory measurement of oesophageal pH and pressure: A digital recording system and computer-aided manometry analysis. J Ambul Monit 3:47–62, 1990
Arndorfer RC, Stef JJ, Dodds WJ, Linehan JH, Hogan WJ: Improved infusion system for intraluminal oesophageal manometry. Gastroenterology 73:23–27, 1977
Pearson ES, Hartley HO: Biometrika Tables for Statisticians. Cambridge, University Press, 1976
Wilcoxon F, Wilcox RA: Some Rapid Approximate Statistical Procedures. New York, Lederle Laboratories, 1974
Bumm R, Emde C, Armstrong D, Bauerfeind P, Blum AL: Ambulatory esophageal manometry: Comparison of expert and computer-aided analysis. J Gastrointest Motil 2:216–223, 1990
Emde C, Armstrong D, Castiglione F, Cilluffo T, Riecken EO, Blum AL: Reproducibility of long-term ambulatory esophageal combined pH/manometry. Gastroenterology 100:1630–1637, 1991
Armstrong D, Emde C, Bumm R, Castiglione F, Cilluffo T, Blum AL: Twenty-four-hour pattern of esophageal motility in asymptomatic volunteers. Dig Dis Sci 35:1190–1197, 1990
Castell DO, Dubois A, Davis CR, Cordova CM, Norman DO: Computer-aided analysis of human esophageal peristalsis. I. Technical description and comparison with manual analysis. Dig Dis Sci 29:65–72, 1984
Castell JA, Castell DO: Computer analysis of human esophageal peristalsis and lower esophageal sphincter pressure. II. An interactive system for on-line data collection and analysis. Dig Dis Sci 31:1211–1216, 1986
Sarna S: Computer-aided analysis of human esophageal peristalsis. Dig Dis Sci 29:73–74, 1984
Janssens J, Vantrappen G, Ghillebert G: 24-hour recording of esophageal pressure and pH in patients with noncardiac chest pain. Gastroenterology 90:1978–1984, 1986
Smout AJPM, Breedijk M, van der Zouw C, Akkermans LMA: Physiological gastroesophageal reflux and esophageal motor activity studied with a new system for 24-hour recording and automated analysis. Dig Dis Sci 34:372–378, 1989
Treacy W, Baggenstoss A, Solcumb C, Code CF: Scleroderma of the esophagus. A correlation of histologic and physiologic findings. Ann Intern Med 59:351–356, 1963
Cohen S, Lipshutz W: Lower esophageal sphincter function in achalasia. Gastroenterology 61:814–820, 1971
Richter JE, Castell DO: 24 hour ambulatory oesophageal motility monitoring: How should motility data be analysed? 30:1040–1047, 1989
Armstrong D, Emde C, Blum AL: Twenty-four-hour intragastric pH-metry studies: Easy to do but difficult to analyse. Eur J Gastroenterol Hepatol 1:167–174, 1989
Author information
Authors and Affiliations
Additional information
Supported by Deutsche Forschungsgemeinschaft grant Em 36/2-1 and by Swiss National Foundation grant 32-26369.89
Rights and permissions
About this article
Cite this article
Emde, C., Armstrong, D. & Blum, A.L. Computer-assisted ambulatory long-term manometry of tubular esophagus. Digest Dis Sci 36, 90S–97S (1991). https://doi.org/10.1007/BF01300603
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01300603