Estimation of oestrogen and progesterone receptors in chronic rhinitis

Physiological augmentation of esophageal distension pressure and peristalsis during conditions of increased esophageal emptying resistance

BACKGROUND

Abdominal compression has been implemented as a provocative maneuver in high-resolution impedance manometry (HRIM) to "challenge" normal esophageal physiology with the aim of revealing abnormal motor patterns which may explain symptoms. In this study, we measured the effects of abdominal compression on esophageal functioning utilizing novel pressure-impedance parameters and attempted to identify differences between healthy controls and globus patients.

METHODS

Twenty-two healthy volunteers (aged 23-32 years, 41% female) and 22 globus patients (aged 23-72 years, 68% female) were evaluated with HRIM using a 3.2-mm water perfused manometric and impedance catheter. All participants received 10 × 5 mL liquid swallows; healthy controls also received 10 × 5 mL liquid swallows with abdominal compression created using an inflatable cuff. All swallows were analyzed to assess esophageal pressure topography (EPT) and pressure-flow metrics, indicative of distension pressure, flow timing and bolus clearance were derived.

KEY RESULTS

The effect of abdominal compression was shown as a greater contractile vigor of the distal esophagus by EPT and higher distension pressure based on pressure-flow metrics. Age and body mass index also increased contractile vigor and distension pressure. Globus patients were similar to controls.

CONCLUSIONS AND INTERFERENCES

Intrabolus pressure and contractile vigor are indicative of the physiological modulation of bolus transport mechanisms. Provocative testing by abdominal compression induces changes in these esophageal bolus dynamics.

Association between swallow perception and esophageal bolus clearance in patients with globus sensation

BACKGROUND

Globus sensation is common, but its pathogenesis is not yet clear.

AIMS

Our purpose was to investigate subjective perception of swallowing and esophageal motility by combined multichannel intraluminal impedance and manometry (MII-EM) for patients with globus sensation.

METHODS

Combined MII-EM was performed for 25 globus patients and 15 healthy controls. Swallows were abnormal if hypocontractivity or simultaneous contractions occurred. Esophageal bolus transit was incomplete if bolus exit was not found at one or more of all measurement sites. Perception of each swallow was assessed by use of a standardized scoring system, and was enhanced if the score was >1.

RESULTS

Few globus patients reported enhanced perception during viscous or solid swallows. Incomplete bolus transit and enhanced perception occurred similarly between viscous and solid boluses. Agreement between enhanced perception and proximal bolus clearance was greater during solid swallows (κ = 0.45, 95 % CI: 0.32-0.58) than during viscous swallows (κ = 0.13, 95 % CI: 0-0.25) (P < 0.05). Similarly, agreement between enhanced perception and total bolus clearance was greater during solid swallows (κ = 0.46, 95 % CI: 0.34-0.58) than during viscous swallows (κ = 0.11, 95 % CI: 0-0.22) (P < 0.05).

CONCLUSIONS

Enhanced swallow perception is uncommon in patients with globus sensation, although there is a significant association between enhanced esophageal perception and solid bolus clearance. Application of a solid bolus may help better delineation of the interrelationship between the subjective perception of bolus passage and the objective measurement of bolus clearance.

Nasal congestion during the menstrual cycle

Oestrogens have been considered to cause nasal congestion during the menstrual cycle and during pregnancy. The aim of the present study was to evaluate the degree of nasal congestion during the menstrual cycle in healthy women. Nasal peak expiratory flow (nPEF) was measured and subjective nasal stuffiness was scored morning and evening by 27 women for 3 months and by 14 women for 6 months. During the menstrual days, when the serum oestrogen level is lowest, the morning nPEFs were significantly lower compared with the rest of the cycle (P = 0.0012). The difference was most pronounced for the second day of the cycle (P = 0.00034). The correlation between nPEFs and the subjective scores was high (R = 0.98), while the coefficient of variation within the series of three nPEF recordings was low (6.4%). It is concluded that the nasal obstruction experienced during menstruation cannot be explained by increased serum levels of oestrogen.