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Neurogastroenterology and Motility Jul 2022Although esophageal dysmotility is common in systemic sclerosis (SSc)/scleroderma, little is known regarding the pathophysiology of motor abnormalities driving reflux...
BACKGROUND
Although esophageal dysmotility is common in systemic sclerosis (SSc)/scleroderma, little is known regarding the pathophysiology of motor abnormalities driving reflux severity and dysphagia. This study aimed to assess primary and secondary peristalsis in SSc using a comprehensive esophageal motility assessment applying high-resolution manometry (HRM) and functional luminal imaging probe (FLIP) Panometry.
METHODS
A total of 32 patients with scleroderma (28 female; ages 38-77; 20 limited SSc, 12 diffuse SSc) completed FLIP Panometry and HRM. Secondary peristalsis, i.e., contractile responses (CR), was classified on FLIP Panometry by pattern of contractility as normal (NCR), borderline (BCR), impaired/disordered (IDCR), or absent (ACR). Primary peristalsis on HRM was assessed according to the Chicago classification.
RESULTS
The manometric diagnoses were 56% (n = 18) absent contractility, 22% (n = 7) ineffective esophageal motility (IEM), and 22% (n = 7) normal motility. Secondary peristalsis (CRs) included 38% (n = 12) ACR, 38% (n = 12) IDCR, 19% (n = 6) BCR, and 15% (n = 5) NCR. The median (IQR) esophagogastric junction (EGJ) distensibility index (DI) was 5.8 mm /mmHg (4.8-10.1) mm /mmHg; EGJ-DI was >8.0 mm /mmHg in 31%, and >2.0 mm /mmHg in 100% of patients. Among 18 patients with absent contractility on HRM, 11 had ACR, 5 had IDCR, and 2 had BCR. Among 7 patients with IEM, 1 had ACR, 5 had IDCR, and 1 NCR. All of the patients with normal peristalsis had NCR or BCR.
CONCLUSIONS
This was the first study assessing combined HRM and FLIP Panometry in a cohort of SSc patients, which demonstrated heterogeneity in primary and secondary peristalsis. This complementary approach facilitates characterizing esophageal function in SSc, although future study to examine clinical outcomes remains necessary.
Topics: Adult; Aged; Esophageal Motility Disorders; Female; Humans; Manometry; Middle Aged; Peristalsis; Scleroderma, Systemic
PubMed: 34709690
DOI: 10.1111/nmo.14284 -
Advances in Experimental Medicine and... 2022In the last decade, we characterized an enteric neuronal subpopulation of multifunctional mechanosensitive enteric neurons (MEN) while studying the gastrointestinal...
In the last decade, we characterized an enteric neuronal subpopulation of multifunctional mechanosensitive enteric neurons (MEN) while studying the gastrointestinal peristalsis. MEN have been described in a variety of gastrointestinal regions and species. This chapter summarizes existing data on MEN, describing their proportions, firing behaviors, adaptation musters, and chemical phenotypes. We also discuss MEN sensitivity to different mechanical stimulus qualities such as compression and tension along with pharmacology of their responses.
Topics: Neurons; Intestine, Small; Peristalsis; Enteric Nervous System
PubMed: 36587145
DOI: 10.1007/978-3-031-05843-1_5 -
Gastroenterology Oct 2022
Topics: Gastrointestinal Motility; Humans; Indicators and Reagents; Intestinal Obstruction; Intestinal Pseudo-Obstruction; Peristalsis
PubMed: 35643176
DOI: 10.1053/j.gastro.2022.05.033 -
Advances in Experimental Medicine and... 2019The peristaltic pressure waves in the renal pelvis that propel urine expressed by the kidney into the ureter towards the bladder have long been considered to be... (Review)
Review
The peristaltic pressure waves in the renal pelvis that propel urine expressed by the kidney into the ureter towards the bladder have long been considered to be 'myogenic', being little affected by blockers of nerve conduction or autonomic neurotransmission, but sustained by the intrinsic release of prostaglandins and sensory neurotransmitters. In uni-papilla mammals, the funnel-shaped renal pelvis consists of a lumen-forming urothelium and a stromal layer enveloped by a plexus of 'typical' smooth muscle cells (TSMCs), in multi-papillae kidneys a number of minor and major calyces fuse into a large renal pelvis. Electron microscopic, electrophysiological and Ca imaging studies have established that the pacemaker cells driving pyeloureteric peristalsis are likely to be morphologically distinct 'atypical' smooth muscle cells (ASMCs) that fire Ca transients and spontaneous transient depolarizations (STDs) which trigger propagating nifedipine-sensitive action potentials and Ca waves in the TSMC layer. In uni-calyceal kidneys, ASMCs predominately locate on the serosal surface of the proximal renal pelvis while in multi-papillae kidneys they locate within the sub-urothelial space. 'Fibroblast-like' interstitial cells (ICs) located in the sub-urothelial space or adventitia are a mixed population of cells, having regional and species-dependent expression of various Cl, K, Ca and cationic channels. ICs display asynchronous Ca transients that periodically synchronize into bursts that accelerate ASMC Ca transient firing. This review presents current knowledge of the architecture of the proximal renal pelvis, the role Ca plays in renal pelvis peristalsis and the mechanisms by which ICs may sustain/accelerate ASMC pacemaking.
Topics: Animals; Calcium; Interstitial Cells of Cajal; Ion Channels; Kidney Pelvis; Muscle Contraction; Peristalsis; Ureter
PubMed: 31183823
DOI: 10.1007/978-981-13-5895-1_3 -
Soft Robotics Jun 2021The human stomach breaks down and transports food by coordinated radial contractions of the gastric walls. The radial contractions periodically propagate through the...
The human stomach breaks down and transports food by coordinated radial contractions of the gastric walls. The radial contractions periodically propagate through the stomach and constitute the peristaltic contractions, also called the gastric motility. The force, amplitude, and frequency of peristaltic contractions are relevant to massaging and transporting the food contents in the gastric lumen. However, existing gastric simulators have not faithfully replicated gastric motility. Herein, we report a soft robotic gastric simulator (SoGut) that emulates peristaltic contractions in an anatomically realistic way. SoGut incorporates an array of circular air chambers that generate radial contractions. The design and fabrication of SoGut leverages principles from the soft robotics field, which features compliance and adaptability. We studied the force and amplitude of the contractions when the lumen of SoGut was empty or filled with contents of different viscosity. We examined the contracting force using manometry. SoGut exhibited a similar range of contracting force as the human stomach reported in the literature. Besides, we investigated the amplitude of the contractions through videofluoroscopy where the contraction ratio was derived. The contraction ratio as a function of inflation pressure is found to match the observations of situations. We demonstrated that SoGut can achieve peristaltic contractions by coordinating the inflation sequence of multiple air chambers. It exhibited the functions to massage and transport the food contents. SoGut can simulate the physiological motions of the human stomach to advance research of digestion.
Topics: Digestion; Humans; Manometry; Peristalsis; Robotics; Stomach
PubMed: 32559391
DOI: 10.1089/soro.2019.0136 -
Advances in Experimental Medicine and... 2016Over the past few years, there have been dramatic changes in our understanding of the role of endogenous 5-hydroxytryptamine (5-HT) in the generation of gastrointestinal... (Review)
Review
Over the past few years, there have been dramatic changes in our understanding of the role of endogenous 5-hydroxytryptamine (5-HT) in the generation of gastrointestinal (GI) motility patterns in the small and large intestine. The idea that endogenous 5-HT played a major role in the generation of peristalsis in the small intestine was first proposed in the mid 1950s, after it was discovered that endogenous 5-HT could be released from the mucosa at a similar time that peristalsis occurred; and that exogenous 5-HT could potently stimulate peristalsis. The fact that exogenous 5-HT stimulated peristalsis and that there was a similarity in timing between the release of 5-HT from the mucosa and the onset of peristalsis led investigators to propose that release of endogenous 5-HT from the mucosa was causally related to the generation of peristalsis. In further support of this, other studies showed that selective 5-HT antagonists could inhibit or block peristalsis, and other motor patterns, such as the migrating motor complex. Taken together, based on these findings, some laboratories believed that endogenous 5-HT (synthesized in the gut wall) was an important mediator, or initiator, of different propulsive motor patterns in the lower GI tract. This notion changed dramatically in the past few years, however, after it was discovered that removal of the mucosa abolished all cyclical release of endogenous 5-HT, but did not block peristalsis, nor the cyclical migrating complex. Furthermore, other laboratories revealed that genetic deletion of the gene tryptophan hydroxylase 1 (TPH-1) (that synthesizes endogenous 5-HT in the mucosa) actually had no inhibitory effect on transit of intestinal contents in live animals. Then, perhaps one of the most startling of all observations was the discovery that selective 5-HT receptor antagonists actually have the same inhibitory effects on peristalsis and the migrating complex in segments of intestine that had been depleted of all endogenous 5-HT. Taken together, these recent findings have led to a major revision in our understanding of the functional role of endogenous 5-HT in the generation of propulsive motor patterns in the lower GI tract. This review will focus on how our understanding of endogenous 5-HT in the GI tract has changed substantially in recent times.
Topics: Animals; Gastrointestinal Motility; Gastrointestinal Tract; Humans; Intestinal Mucosa; Peristalsis; Serotonin
PubMed: 27379639
DOI: 10.1007/978-3-319-27592-5_11 -
PloS One 2018Understanding complex abdominal organ motion is essential for motion management in radiation therapy (RT) of abdominal tumors. This study investigates abdominal motion...
PURPOSE
Understanding complex abdominal organ motion is essential for motion management in radiation therapy (RT) of abdominal tumors. This study investigates abdominal motion induced by respiration and peristalsis, during various time durations relevant to RT, using various CT and MRI techniques acquired under free breathing (FB) and breath hold (BH).
METHODS
A series of CT and MRI images acquired with various techniques under free breathing and/or breath hold from 37 randomly-selected pancreatic or liver cancer patients were analyzed to assess the motion in various time frames. These data include FB 4DCT from 15 patients (for motion in time duration of 5 sec), FB 2D cine-MRI from 4 patients (time duration of 1.7 min, 1 second acquisition time per slice), FB cine-MRI acquired using MR-Linac from 6 patients in various fractions (acquisition time is less than 0.6 seconds per slice), FB 4DMRI from 2 patients (time duration of 2 min), respiration-gated T2 with gating at the end expiration (time duration of 3-5 min), and BH T1 with multiphase dynamic contrast in acquisition times of 17 seconds for each of five phases (pre-contrast, arterial, venous, portal venous and delayed post-contrast) from 10 patients. Motions of various organs including gallbladder (GB) and liver were measured based on these MRI data. The GB motion includes both respiration and peristalsis, while liver motion is primarily respiration. By subtracting liver motion (respiration) from GB motion (respiration and peristalsis), the peristaltic motion, along with small residual motion, was obtained.
RESULTS
From cine-MRI, the residual motion beyond the respiratory motion was found to be up to 0.6 cm in superior-inferior (SI) and 0.55 cm in anterior-posterior (AP) directions. From 2D cine-MRI acquired by the MR-Linac, different peristaltic motions were found from different fractions for each patient. The peristaltic motion was found to vary between 0.3-1 cm. From BH T1 phase images, the average motions that were primarily due to peristalsis movements were found to be 1.2 cm in SI, 0.7 cm in AP, and 0.9 cm in left-right (LR) directions. The average motions assessed from 4DCT were 1.0 cm in SI and 0.3 cm in AP directions, which were generally smaller than the motions assessed from cine-MRI, i.e., 1.8 cm in SI and 0.6 cm in AP directions, for the same patients. However, average motions from 4DMRI, which are coming from respiratory were measured to be 1.5, 0.5, and 0.4 cm in SI, AP, and LR directions, respectively.
CONCLUSION
The abdominal motion due to peristalsis can be similar in magnitude to respiratory motion as assessed. These motions can be irregular and persistent throughout the imaging and RT delivery procedures, and should be considered together with respiratory motion during RT for abdominal tumors.
Topics: Duodenum; Four-Dimensional Computed Tomography; Humans; Imaging, Three-Dimensional; Liver Neoplasms; Magnetic Resonance Imaging; Motion; Pancreas; Pancreatic Neoplasms; Peristalsis
PubMed: 30359413
DOI: 10.1371/journal.pone.0205917 -
Journal of Gastroenterology and... Dec 2021Opioid receptors agonists have been demonstrated to impair lower esophageal sphincter (LES) relaxation and induce spastic esophageal dysmotility, but little was known...
BACKGROUND AND AIM
Opioid receptors agonists have been demonstrated to impair lower esophageal sphincter (LES) relaxation and induce spastic esophageal dysmotility, but little was known for their impact on distension-induced secondary peristalsis. The aim of the study was to investigate the hypothesis whether acute administration of codeine can influence physiological characteristics of primary and secondary peristalsis in healthy adults.
METHODS
Eighteen healthy volunteers (13 men, mean age 27.5 years, aged 20-43 years) underwent high resolution manometry (HRM) with a catheter containing an injection port in mid-esophagus. Secondary peristalsis was performed with 10 and 20 mL rapid air injections. Two different sessions including acute administration of codeine (60 mg) or the placebo were randomly performed.
RESULTS
Codeine significantly increased 4-s integrated relaxation pressure (IRP-4s) (P = 0.003) and shortened distal latency (DL) (P = 0.003) of primary peristalsis. The IRP-4s of secondary peristalsis was also significantly higher after codeine than the placebo during air injections with 10 mL (P = 0.048) and 20 mL (P = 0.047). Codeine significantly increased the frequency of secondary peristalsis during air injections with 10 mL than the placebo (P = 0.007), but not for air injection with 20 mL (P = 0.305).
CONCLUSIONS
In addition to impair LES relaxation and reduce distal latency of primary peristalsis, codeine impairs LES relaxation of secondary peristalsis and increases secondary peristaltic frequency. Our study supports the notion in human esophagus that the impact of opioids on peristaltic physiology appears to be present in both primary and secondary peristalsis.
Topics: Adult; Codeine; Esophagus; Female; Humans; Male; Manometry; Peristalsis; Young Adult
PubMed: 34322907
DOI: 10.1111/jgh.15641 -
World Journal of Gastroenterology Sep 2016Idiopathic achalasia is an archetype esophageal motor disorder, causing significant impairment of eating ability and reducing quality of life. The pathophysiological... (Review)
Review
Idiopathic achalasia is an archetype esophageal motor disorder, causing significant impairment of eating ability and reducing quality of life. The pathophysiological underpinnings of this condition are loss of esophageal peristalsis and insufficient relaxation of the lower esophageal sphincter (LES). The clinical manifestations include dysphagia for both solids and liquids, regurgitation of esophageal contents, retrosternal chest pain, cough, aspiration, weight loss and heartburn. Even though idiopathic achalasia was first described more than 300 years ago, researchers are only now beginning to unravel its complex etiology and molecular pathology. The most recent findings indicate an autoimmune component, as suggested by the presence of circulating anti-myenteric plexus autoantibodies, and a genetic predisposition, as suggested by observed correlations with other well-defined genetic syndromes such as Allgrove syndrome and multiple endocrine neoplasia type 2 B syndrome. Viral agents (herpes, varicella zoster) have also been proposed as causative and promoting factors. Unfortunately, the therapeutic approaches available today do not resolve the causes of the disease, and only target the consequential changes to the involved tissues, such as destruction of the LES, rather than restoring or modifying the underlying pathology. New therapies should aim to stop the disease at early stages, thereby preventing the consequential changes from developing and inhibiting permanent damage. This review focuses on the known characteristics of idiopathic achalasia that will help promote understanding its pathogenesis and improve therapeutic management to positively impact the patient's quality of life.
Topics: Adrenal Insufficiency; Autoantibodies; Autoimmune Diseases; Deglutition Disorders; Esophageal Achalasia; Esophageal Motility Disorders; Esophageal Sphincter, Lower; Heartburn; Humans; Inflammation; Manometry; Myenteric Plexus; Peristalsis; Quality of Life
PubMed: 27672286
DOI: 10.3748/wjg.v22.i35.7892 -
Journal of Clinical GastroenterologyJackhammer esophagus (JE) is a recently recognized esophageal motility disorder that is characterized by hypercontractile peristalsis. More than 500 cases have been...
Jackhammer esophagus (JE) is a recently recognized esophageal motility disorder that is characterized by hypercontractile peristalsis. More than 500 cases have been reported in the literature. Among patients referred for esophageal motility disorders, the prevalence of JE ranges from 0.42% to 9%, with most series describing a prevalence of 2% to 4%. Most cases are women (60.5%). The mean reported age of patients with JE is 65.2 years, and patients commonly have dysphagia (62.8%). Reflux symptoms occur in ∼40% of patients, and chest pain affects more than one-third of patients (36.4%). JE is a heterogenous disorder that is associated with several conditions, including obesity, opioid use, lung transplantation, eosinophilic infiltration of the esophagus, neoplasia, and systemic diseases. The cause and pathogenesis remain unknown, but several observations suggest that it is the result of multiple conditions that likely precipitate increased excitation and abnormal inhibition of neuromuscular function. The natural course of JE also is unknown, but progression to achalasia has been observed in a few patients. Treatment is challenging, in part because of the insufficient understanding of the disorder's underlying mechanisms. Various therapeutic modalities have been used, ranging from observation only to pharmacologic and endoscopic interventions (eg, botulinum toxin injection) to peroral endoscopic myotomy. Treatment efficacy remains largely anecdotal and insufficiently studied.
Topics: Aged; Esophageal Achalasia; Esophageal Motility Disorders; Female; Humans; Manometry; Peristalsis
PubMed: 33337637
DOI: 10.1097/MCG.0000000000001472