Esophageal swallowing phase assessed by audiosignal recording - Relationship with manometry in gastroesophageal reflux disease patients

The acoustic technique has been used for pharyngeal exploration but to date no such technique has been devised to assess esophageal motility. The aim of this study was to demonstrate that displacement through the esophagus ca n be quantified using this method in healthy subjects and in patients with gastroesophageal reflux. Concurrent manometric and acoustic recordings were also performed in the patients. Fifteen controls (38.5 +/- 13 years old) a nd 10 patients (34.9 +/- 6 years old) were included. All were recorded duri ng wet and dry swallow sequences with microphones placed below the cricoid cartilage and on the xiphoid appendix. Standard manometry was performed for lower esophageal sphincter (LES) exploration. For the acoustic technique, the frequency of xiphoid signals (FX), esophageal transit time (ETT), durat ion of xiphoid sound (SD), and for the manometric study, the duration of LE S relaxation (RD) were recorded and mean values were calculated (FXm), (ETT m), (SDm), (RDm). FXm for wet (94 vs 81.6%) and dry swallows (86 vs 66.6%) decreased in patients. ETTm was significantly higher (P < 0.01) for wet tha n for dry swallows (5.6 +/- 0.9 vs 5.2 +/- 1.2 sec) for controls but not fo r patients. ETTm was significantly higher for patients for wet (7.2 +/- 2.1 sec) and for dry swallows (6.5 +/- 2.3 sec) than for controls and SDm was lower. Xiphoid sound appeared in the second half of LES relaxation. Our non invasive acoustic technique is simple and reproducible. It is well correlat ed with manometry, and it allows characterization of the displacement of th e bolus through the esophagus and the LES. The technique could be used alon e to determine appropriate pharmacological and surgical treatments for esop hageal motility disorders.