Development of a topographic analysis system for manometric studies in the gastrointestinal tract,☆☆,

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Abstract

Background: Intraluminal pressures from the gastrointestinal tract are conventionally analyzed from a set of two-dimensional tracings. We hypothesized that more information could be extracted by considering spatial relationships of pressure data. Methods: A system was developed for recording pressure from up to 21 sites and analyzing the results using two- and three-dimensional plotting methods connecting data in space as well as time. Esophageal pressures were measured in 10 volunteers. Data were displayed as three-dimensional contour plots, surface plots, or animated transformations of the pressure wave as it traveled axially in the direction of bolus movement. Results: Subjects tolerated catheter placement, and all analysis methods (conventional and topographic) were successfully completed in each case. At least 80% of the esophageal body and one sphincter could be sampled with the catheter in either a proximal or distal recording position. Conclusions: A topographic analysis system is available for studying time and space relationships of pressure data. These novel techniques have the potential to provide greater insight into normal and abnormal gastrointestinal motor function than conventional manometric methods.

Section snippets

Subjects

Ten asymptomatic volunteers (median age 32, range 25 to 53 years; 5 women, 5 men) were recruited to undergo esophageal manometry. None of the subjects had any esophageal symptoms, had been treated for any esophageal disorders, had undergone esophageal or upper gastrointestinal surgery, or were taking any medications that would influence esophageal motility. The performance of manometry on asymptomatic volunteers was approved by our Human Studies Committee (IRB) before inception of the study.

Data acquisition methods

RESULTS

Each subject tolerated placement of the silicone catheter without difficulty. Correct positioning within the upper or lower esophageal sphincter was easily determined by viewing the conventional wave forms during real-time data acquisition. Conventional wave forms were displayed, both during data acquisition and analysis, as three sets of seven tracings on the monitor, each set in a distinctive color so that overlapping tracings could be easily discerned. In the proximal position, 89.9% ± 2.3%

DISCUSSION

In this report we describe the development and application in the human esophagus of methods required for topographic analysis of manometric data. The catheter system used was well tolerated by the subjects, and the recording characteristics of this catheter match those of conventional extruded catheters having fewer lumens, being sufficient for accurate recording of esophageal pressures.2, 8 Modifications may be required for recording from other parts of the gastrointestinal tract depending on

Acknowledgements

We thank Dominic Bellino, Arjen de Weerd, Jan-Willem van der Wal, and Albert Meek of Medical Measurement Systems (MMS) for their interest, support, and outstanding technical skills in assisting development of the methods described in this report. We also thank Laura Haroian, RN, for assistance in the performance of the manometric studies.

The authors have no financial or other interests in the manufacture or distribution of the manometric system described in this paper.

References (11)

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From the Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri.

☆☆

Reprint requests: Ray E. Clouse, MD, Professor of Medicine, Barnes-Jewish Hospital, 216 S. Kingshighway Blvd., Suite 6330, St. Louis, MO 63110-1092.

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