1. Esophageal Motor Dysfunction and Gastroesophageal Reflux Are Prevalent in Lung Transplant Candidates 
Benjamin Basseri, MD, Jeffrey L. Conklin, MD, Mark Pimentel, MD, Robert Tabrizi, MD, Edward H. Phillips, MD, Sinan A. Simsir, MD, George E. Chaux, MD, Jeremy A. Falk, MD, Sara Ghandehari, MD, Harmik J. Soukiasian, MD 
The Annals of Thoracic Surgery 
Volume 90, Issue 5, Pages (November 2010)
DOI: /j.athoracsur
Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
Normal high-resolution manometry color contour after a wet swallow. Pressure is represented by color (color bar), sensor location in distance from the nares (y axis), and time is on the x axis. Resting upper (UES) and lower esophageal sphincter (LES) pressures are seen as horizontal bands of color indicating higher pressures than in the adjacent pharynx, esophagus, or stomach. Opening of the UES and LES relaxation are depicted as color changes that indicate lower pressure: UES pressure approximates that in the esophagus (*), and LES pressure approximates that in the stomach (**). Peristaltic pressure wave is portrayed as a diagonal band of color from the UES to the LES; higher pressure in striated muscle segment diminishes over the transition zone and increases in amplitude in the smooth muscle esophagus. Pressure in the swallowed bolus (intrabolus pressure) is small, a simultaneous rise in intraesophageal pressure (arrow) that occurs shortly after initiation of a wet swallow. It remains elevated ahead of the peristaltic pressure wave.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
High-resolution manometry color contour in a lung transplantation candidate with a hypotensive upper esophageal sphincter (UES). Wet swallow timing is indicated by WS. Pressure changes caused by inspiration (I) and expiration (E) are easily identified. Pressure becomes more negative in the esophagus during inspiration and more positive during expiration, indicating the sensors are intrathoracic. Notice that the resting pressure in the upper esophageal sphincter varies with the respiratory cycle and drops below 20 mm Hg with inspiration (*). (LES = lower esophageal sphincter.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
High-resolution manometry color contour from a lung transplantation candidate with elevated residual pressure in the upper esophageal sphincter (UES) and elevated bolus pressure in the pharynx. The time base is expanded to get a clear look at pressure events in the UES and pharynx (*). Normally, pressure in the UES and pharynx approximate adjacent esophagus when the UES is open. Pharyngeal and UES pressures are elevated during UES opening (*), indicating a pharyngeal motor abnormality or obstruction at the UES. Fluoroscopic swallowing study identified a cricopharyngeal bar. (LES = lower esophageal sphincter.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

5. Fig 4
Esophageal motor dysfunction, hypotensive lower esophageal sphincter (LES) and upper esophageal sphincter (UES) “microburps.” In this high-resolution manometry color contour from a lung transplantation candidate, wet swallows (WS) do not produce normal peristalsis in the smooth muscle esophagus. At the gastroesophageal (GE) junction, contraction of the diaphragm is seen as pressure increases in association with inspiration. During expiration, pressure at the GE junction drops to approximate intragastric pressure, indicating that LES resting pressure is low. Notice that there are very short duration openings of the UES that are not associated with swallowing (*). This patient had small burps coinciding with these opening events.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

6. Fig 5
Mean proportion of peristaltic, hypotensive, and aperistaltic swallows in lung transplantation (LTx) candidates and control subjects.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions