Esophageal Swallowing Phase Assessed by Audiosignal Recording (Relationship with Manometry in Gastroesophageal Reflux Disease Patients)

Abstract

The acoustic technique has been used forpharyngeal exploration but to date no such technique hasbeen devised to assess esophageal motility. The aim ofthis study was to demonstrate that displacement through the esophagus can be quantified using thismethod in healthy subjects and in patients withgastroesophageal reflux. Concurrent manometric andacoustic recordings were also performed in the patients.Fifteen controls (38.5 ± 13 years old) and 10patients (34.9 ± 6 years old) were included. Allwere recorded during wet and dry swallow sequences withmicrophones placed below the cricoid cartilage and onthe xiphoid appendix. Standard manometry wasperformed for lower esophageal sphincter (LES)exploration. For the acoustic technique, the frequencyof xiphoid signals (FX), esophageal transit time (ETT),duration of xiphoid sound (SD), and for the manometricstudy, the duration of LES relaxation (RD) were recordedand mean values were calculated (FXm), (ETTm), (SDm),(RDm). FXm for wet (94 vs 81.6%) and dry swallows (86 vs 66.6%) decreased in patients. ETTm wassignificantly higher (P < 0.01) for wet than for dryswallows (5.6 ± 0.9 vs 5.2 ± 1.2 sec) forcontrols but not for patients. ETTm was significantly higher for patients for wet (7.2 ± 2.1sec) and for dry swallows (6.5 ± 2.3 sec) thanfor controls and SDm was lower. Xiphoid sound appearedin the second half of LES relaxation. Our noninvasiveacoustic technique is simple and reproducible. It iswell correlated with manometry, and it allowscharacterization of the displacement of the bolusthrough the esophagus and the LES. The technique couldbe used alone to determine appropriate pharmacologicaland surgical treatments for esophageal motilitydisorders.