and/or aims): The long term objective of this project is to determine the value of a quantitative assessment of the upper esophageal sphincter/pharyngeal (UES/P) pressure dynamics in the diagnosis and prognosis of therapy in conditions leading to pharyngeal dysphagia. In order to accomplish this, it will be necessary to first determine these pressure dynamics in normal volunteers. Since many patients suffering from pharyngeal dysphagia are elderly, an assessment of the changes in these dynamics that are a consequence of normal aging will be made. The effects of various postures and types of foods will also be studied. Quantitative assessment of abnormal UES/P dynamics related to neurologic and neuromuscular disorders will be made prior to therapeutic intervention and during treatment. Changes in pressure dynamics will be correlated with clinical response and a predictive model for therapeutic response will be built. UES/P manometry will be performed first in normal volunteers, with a particular emphasis on subjects older than 60 years, using a specially designed catheter to compensate for anatomical difficulties. Patients with a variety of neurologic and neuromuscular disorders will also be studied manometrically. Manometry data will be collected on-line using a computer and an analog to digital converter. Manometric parameters will be determined automatically, using computer generated algorithms. In addition, patients will be studied radiographically with a combination of static and motion images recorded on videotape. Patients will be evaluated by neurologist using a clinical assessment scale appropriate to the disease. A speech-language pathologist will determine the degree and severity of functional dysphagia. All clinicians will be blinded to the manometric results. This multidisciplinary approach will provide several independent scales to determine the severity of the disorder and increase the probability of relating manometric measures to an effect of the disease.
| Johnston, B T; Colcher, A; Li, Q et al. (2001) Repetitive proximal esophageal contractions: a new manometric finding and a possible further link between Parkinson's disease and achalasia. Dysphagia 16:186-9 |
| Hatlebakk, J G; Castell, J A; Spiegel, J et al. (1998) Dilatation therapy for dysphagia in patients with upper esophageal sphincter dysfunction--manometric and symptomatic response. Dis Esophagus 11:254-9 |
| Castell, J A; Castell, D O (1996) Upper esophageal sphincter and pharyngeal function and oropharyngeal (transfer) dysphagia. Gastroenterol Clin North Am 25:35-50 |
| Olsson, R; Castell, J A; Castell, D O et al. (1995) Solid-state computerized manometry improves diagnostic yield in pharyngeal dysphagia: simultaneous videoradiography and manometry in dysphagia patients with normal barium swallows. Abdom Imaging 20:230-5 |
| Nguyen, P; Castell, D O (1994) Stimulation of esophageal mechanoreceptors is dependent on rate and duration of distension. Am J Physiol 267:G115-8 |
