Evaluation of esophageal motility by endosonography using a miniature ultrasonographic probe in patients with reflux esophagitis.

ABSTRACT

BACKGROUND: Although there are several established methods used to evaluate esophageal motility, none allows for direct observation of esophageal wall motion. Esophageal dysmotility is thought to contribute to reflux esophagitis (RE). The aim of this study was to evaluate esophageal wall motility by endosonography using a miniature ultrasonographic probe (MUP) in patients with RE. METHODS: The subjects consisted of 10 healthy controls (10 men with a mean age of 31.5 years) and 9 patients with RE (4 men and 5 women with a mean age of 51.5 years). High-frequency endoluminal sonography was performed using a 20-MHz transducer through a 16F gastric tube to evaluate esophageal wall motion. Four sonographic phases of an esophageal peristaltic sequence were identified. In the resting phase, the esophageal wall was in direct contact with the transducer. In the passive distention phase, the esophageal lumen was stretched maximally; in the contraction phase, it contracted; and in the relaxation phase, it returned to baseline. The baseline thickness of the muscle layers of the esophageal wall was measured at rest. The width decreased during the passive distention phase, increased and reached a maximum during the contraction phase, and returned to baseline during the relaxation phase. RESULTS: The contractility index of the circular smooth muscle (CSM) in the distal esophagus and of the longitudinal smooth muscle (LSM) in the proximal esophagus were significantly lower in patients with RE. The duration of contraction in the distal esophagus was significantly longer in RE. CONCLUSIONS: We used a MUP to demonstrate abnormalities in esophageal wall motility in patients with RE. We conclude that the MUP is a potentially useful technique for evaluating esophageal dysmotility.