Esophageal distension during bolus transport: can it be detected by intraluminal impedance recordings?

BACKGROUND: Esophageal multiple intraluminal impedance (MII) measurement has been used to detect gastro-esophageal reflux and bolus transport. It is not clear if MII can detect changes in luminal cross sectional area (CSA) during bolus transport. Intraluminal ultrasound (US) images, MII, and high resolution manometry (HRM) were recorded simultaneously to determine temporal relationship between CSA and impedance during esophageal bolus transport and to define the relationship between peak distension and nadir impedance. METHODS: Studies were conducted in five healthy subjects. MII, HRM, and US images were recorded 6 cm above LES. Esophageal distensions were studied during swallows and injections of 0.5 N saline bolus into the esophagus. KEY RESULTS: Temporal change in esophageal CSA correlates with changes in impedance (r-value: mean ± SD = -0.80 ± 0.08, range: -0.94 to -0.66). Drop in impedance during distension occurs as a two-step process; initial large drop associated with onset of CSA increase, followed by a small drop during which majority of the CSA increase occurs. Peak CSA and nadir impedance occur within 1 s of each other. Increase in swallow and injection volumes increased the CSA, had no effect on large drop but increased the small drop amplitude. We observed a significant correlation between peak CSA and nadir impedance (r = -0.90, p < 0.001) and a better correlation between peak CSA and inverse impedance (r = 0.94, p < 0.001). CONCLUSIONS & INFERENCES: Further studies are needed to confirm that intraluminal impedance recordings may be used to measure luminal CSA during esophageal bolus transport.

Haemodialysis and charcoal haemoperfusion in acute inorganic mercury poisoning.

A 29-year-old gardener developed acute renal failure following the ingestion of 'Mersil', a combination of mercurous and mercuric chloride, achieving a plasma mercury concentration of 22,000 nmol/litre (400 micrograms/litre). Haemodialysis and charcoal haemoperfusion were ineffective in removing mercury despite prior treatment with the chelating agent dimercaprol. The acute renal failure resolved after 10 days and there are no residual sequelae.