Classification of individual swallows based on HRM pressure topography criteria
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Distal Segment Contraction (referenced to gastric pressure) |
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Classification |
Criteria |
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Normal |
≤ 3 cm defect in the 30 mmHg isobaric contour distal to transition zone (TZ) Contractile Front Velocity (CFVfast*) < 10 cm/s,
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Hypotensive ("ineffective") peristalsis |
Normal appearing wavefront propagation with a >3 cm defect in the 30 mmHg isobaric contour distal to the TZ |
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Absent peristalsis |
No propagating contractile wavefront and minimal (< 3 cm) contractile activity or pressurization greater than the 30 mmHg isobaric contour distal to the TZ |
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Hypertensive peristalsis |
Normal appearing wavefront propagation with a contractile amplitude >180 mmHg (DCI > 5000 mmHg/s/cm) distal to the TZ |
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Spasm |
Rapidly propagated contraction (CFVfast > 10 cm/sec) Focal -- limited to the second or third segment (Clouse characterization)
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Elevated intrabolus pressure (functional obstruction) |
IBP >15mmHg compartmentalized between the EGJ and the peristaltic wavefront |
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Panesophageal pressurization |
Esophageal pressurization from the UES to the EGJ with > 30 mmHg IBP |
# EGJ relaxation pressures can be calculated using the continuous 3 second nadir using the eSleeve or the 4 second integrated relaxation pressure (IRP). Upper limit of normal for both is 15 mmHg
* CFV is often composed of a fast section in the upper smooth muscle esophagus and a slow section in the lower esophagus separated by a clear "deceleration point". The structural correlate of the fast section is the peristaltic smooth muscle contraction and this should be used for classification. The slow section occurs during emptying of the phrenic ampulla and appears to correlate with return of the esophagus into resting position.
TZ, transition zone; CFV, contractile front velocity; DCI, distal contractile integral; IBP, intrabolus pressure; UOS, upper oesophageal sphincter.
Source: Pandolfino, Fox, Bredenoord, Kahrilas Neurogastro Motil 2009, modified following HRM consensus group meeting 29th August 2009
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