Phrenic Ampulla Emptying Dysfunction in Patients with Esophageal Symptoms

Sujin Kim; Walter Marquez-Lavenant; Ravinder K Mittal

doi:10.5056/jnm23162

J Neurogastroenterol Motil https://doi.org/10.5056/jnm23162

Phrenic Ampulla Emptying Dysfunction in Patients with Esophageal Symptoms

Sujin Kim,¹ Walter Marquez-Lavenant,² and Ravinder K Mittal

^2*

¹Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Gyeongsangnam-do, Korea; and ²Division of Gastroenterology, Department of Medicine, University of California San Diego, San Diego, CA, USA

Correspondence to: *Ravinder K Mittal, MD
Division of Gastroenterology, Department of Medicine, University of California San Diego, ACTRI, 9500 Gillman Drive, MC 0061, La Jolla, CA 92093-0990, USA
Tel: +1-858-543-3328, E-mail: rmittal@ucsd.edu

Received: October 12, 2023; Revised: November 11, 2023; Accepted: February 27, 2024; Published online: August 14, 2024

Abstract: Background/Aims
Pharyngeal pump, esophageal peristalsis, and phrenic ampulla emptying play important roles in the propulsion of bolus from the mouth to the stomach. There is limited information available on the mechanism of normal and abnormal phrenic ampulla emptying. The goal of our study is to describe the relationship between bolus flow and esophageal pressure profiles during the phrenic ampulla emptying in normal subjects and patient with phrenic ampulla dysfunction.
Methods
Pressure (using topography) and bolus flow (using changes in impedance) relationship through the esophagus and phrenic ampulla were determined in 15 normal subjects and 15 patients with retrograde escape of bolus from the phrenic ampulla into esophagus during primary peristalsis.
Results
During the phrenic ampulla phase, 2 high pressure peaks (proximal, related to lower esophageal sphincter and distal, related to crural diaphragm) were observed in normal subjects and patients during the phrenic ampulla emptying phase. The proximal was always higher than the distal one in normal subjects; in contrast, reverse was the case in patients with the retrograde escape of bolus from the phrenic ampulla into the esophagus.
Conclusions
We propose that a strong after-contraction of the lower esophageal sphincter plays an important role in the normal phrenic ampullary emptying. A defective lower esophageal after-contraction, along with high crural diaphragm pressure are responsible for the phrenic ampulla emptying dysfunction.; Keywords: Esophageal dysphagia; Esophageal motility disorders; Manometry