Impedance i

Swallow Atlas

Weak Peristalsis
 Complete or Incomplete Bolus Transit Peristaltic  Low or Nontransmitted Esophageal Contractions (< 30 mmHg)  Normal or Low LES Pressure  Complete LES Relaxation

Incomplete Bolus Transit

Low or Nontransmitted Esophageal Body Contractions Complete LES Relaxation

Nutcracker Esophagus
C  omplete Bolus Transit  Peristaltic or Fast Antegrade  High Esophageal Amplitude with Prolonged Duration  Normal or High LES Pressure  Complete or Incomplete LES Relaxation

Complete Bolus Transit

UES High Esophageal Body Amplitude Incomplete LES Relaxation

Achalasia
I ncomplete Bolus Transit  Aperistaltic  Low Esophageal Amplitude  High LES Pressure  Incomplete LES Relaxation

Incomplete Bolus Transit

Absent Peristalsis (Reqd) Low Esophageal Amplitude May have High LES Pressure &/ or Incomplete Relaxation

Hiatal Hernia
D  ouble High Pressure Zone  May have Normal LES Pressure & Relaxation  May have short Esophageal Length

Bolus Transit: May or may not be Complete UES Normal Esophageal Body Amplitude. May have Short Esophageal Length Double High Pressure Zone

DES
C  omplete or Incomplete Bolus Transit  >10% simultaneous, repetitive (>2 peaks) contractions  Prolonged duration (> 6 secs)  Spontaneous contractions  Intermittent normal peristalsis  High amplitude not common

Incomplete Bolus Transit

Simultaneous, Repetitive Contractions Complete LES Relaxation

Scleroderma
I ncomplete Bolus Transit  Weak to Absent Lower Esophageal Contraction  Normal Upper Esophageal Amplitude  Low to Absent LES Pressure (< 10 mmHg)

Incomplete Bolus Transit

Normal Striated Esophageal Body Amplitude Weak to Absent Lower Esophageal Body Amplitude Low to Absent LES Pressure

Bolus Transit

Normal Esophageal Function

 Complete Bolus Transit  UES Relaxation / Pharyngeal Contraction  Normal Motility  Complete LES Relaxation

Pharynx UES Contractility

Esophageal Body

LES

Bolus Transit Benefits

F  ull bolus transit assessment from pharynx to stomach M  easure bolus transit directly manometric predictions of bolus transit are no longer required

High Resolution Manometry Benefits

 Minimize data acquisition effort and time using a single probe position  Optimal data consistency with minimal technique sensitivity  Comprehensive manometric data from pharynx to stomach

Abnormal Peristalsis with Complete Bolus Transit

 Normal UES Coordination  Ineffective Motility  Ineffective Peristalsis  Complete LES Relaxation

Sandhill University a higher level of training and education

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PL-10-011 Rev. 3