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Gastrointestinal Endoscopy Clinics of... Oct 2014The function of the esophagus is transporting nutrients from the oropharyngeal cavity to the stomach. This is achieved by coordinated contractions and relaxation of the... (Review)
Review
The function of the esophagus is transporting nutrients from the oropharyngeal cavity to the stomach. This is achieved by coordinated contractions and relaxation of the tubular esophagus and the upper and lower esophageal sphincter. Multichannel intraluminal impedance monitoring offers quantification of esophageal bolus transit and/or retention without the use of ionizing radiation. Combined with conventional or high-resolution manometry, impedance measurements complement the quantification of esophageal body contraction and sphincter relaxation, offering a more comprehensive evaluation of esophageal function. Further studies evaluating the utility of quantifying bolus transit will help clarify the role and position of impedance measurements.
Topics: Electric Impedance; Esophageal Motility Disorders; Esophageal Sphincter, Lower; Esophagus; Gastrointestinal Transit; Humans; Manometry; Peristalsis
PubMed: 25216905
DOI: 10.1016/j.giec.2014.06.009 -
Clinics in Perinatology Mar 2019Current assessment for and diagnosis of necrotizing enterocolitis (NEC) remain inadequate. The introduction of interrogating bowel with ultrasound when NEC is suspected... (Review)
Review
Current assessment for and diagnosis of necrotizing enterocolitis (NEC) remain inadequate. The introduction of interrogating bowel with ultrasound when NEC is suspected or when NEC has occurred presents greater opportunity to characterize the physical changes that have occurred in the bowel wall structures. The evaluation of bowel by ultrasound has been shown to have high specificity for bowel necrosis. There are current barriers in adoption of these techniques because they have not been integrated into routine diagnostic imaging and are not well incorporated in neonatal medicine.
Topics: Algorithms; Clinical Decision-Making; Enterocolitis, Necrotizing; Humans; Infant, Newborn; Infant, Premature; Intestinal Perforation; Intestines; Peristalsis; Radiography, Abdominal; Sensitivity and Specificity; Ultrasonography; Workflow
PubMed: 30771813
DOI: 10.1016/j.clp.2018.10.006 -
Current Opinion in Gastroenterology Jul 2017To review recent advances in achalasia diagnostics and therapeutics. (Review)
Review
PURPOSE OF REVIEW
To review recent advances in achalasia diagnostics and therapeutics.
RECENT FINDINGS
The cardinal feature of achalasia, impaired lower esophageal sphincter (LES) relaxation, can occur in association with varied patterns of esophageal contractility. The Chicago Classification distinguishes among these as follows: without contractility (type I), with panesophageal pressurization (type II), with premature (spastic) distal esophageal contractions (type III), or even with preserved peristalsis [esophagogastric junction (EGJ) outlet obstruction]. Physiological testing also reveals achalasia-like syndromes that also benefit from achalasia therapies. Coincident with this has been the development of peroral endoscopic myotomy (POEM), an endoscopic technique for performing an esophageal myotomy. Hence, the option now exists to either selectively ablate the LES (pneumatic dilation, laparoscopic Heller myotomy, or POEM) or to ablate the sphincter and create a myotomy along some or the entire adjacent smooth muscle esophagus (POEM). Each achalasia syndrome has unique treatment considerations; type II achalasia responds well to all therapies, whereas type III responds best to POEM.
SUMMARY
Emerging data support the concept that optimal management of achalasia is phenotype-specific, guided by high-resolution manometry, and, in some instance, functional luminal imaging probe studies. This opinion article reviews the varied characteristic and treatment considerations of achalasia syndromes as currently understood.
Topics: Esophageal Achalasia; Esophageal Sphincter, Lower; Humans; Manometry; Natural Orifice Endoscopic Surgery; Peristalsis; Treatment Outcome
PubMed: 28426463
DOI: 10.1097/MOG.0000000000000365 -
American Journal of Physiology.... Sep 2016Muscularis propria throughout the entire gastrointestinal tract including the esophagus is comprised of circular and longitudinal muscle layers. Based on the studies... (Review)
Review
Muscularis propria throughout the entire gastrointestinal tract including the esophagus is comprised of circular and longitudinal muscle layers. Based on the studies conducted in the colon and the small intestine, for more than a century, it has been debated whether the two muscle layers contract synchronously or reciprocally during the ascending contraction and descending relaxation of the peristaltic reflex. Recent studies in the esophagus and colon prove that the two muscle layers indeed contract and relax together in almost perfect synchrony during ascending contraction and descending relaxation of the peristaltic reflex, respectively. Studies in patients with various types of esophageal motor disorders reveal temporal disassociation between the circular and longitudinal muscle layers. We suggest that the discoordination between the two muscle layers plays a role in the genesis of esophageal symptoms, i.e., dysphagia and esophageal pain. Certain pathologies may selectively target one and not the other muscle layer, e.g., in eosinophilic esophagitis there is a selective dysfunction of the longitudinal muscle layer. In achalasia esophagus, swallows are accompanied by the strong contraction of the longitudinal muscle without circular muscle contraction. The possibility that the discoordination between two muscle layers plays a role in the genesis of esophageal symptoms, i.e., dysphagia and esophageal pain are discussed. The purpose of this review is to summarize the regulation and dysregulation of peristalsis by the coordinated and discoordinated function of circular and longitudinal muscle layers in health and diseased states.
Topics: Animals; Esophageal Diseases; Esophagus; Humans; Muscle, Smooth; Peristalsis
PubMed: 27445346
DOI: 10.1152/ajpgi.00182.2016 -
Neurogastroenterology and Motility Apr 2021The aim was to investigate whether there is a difference in secondary peristalsis on high-resolution manometry (HRM) among gastroesophageal reflux disease (GERD)...
BACKGROUND/AIM
The aim was to investigate whether there is a difference in secondary peristalsis on high-resolution manometry (HRM) among gastroesophageal reflux disease (GERD) patients with and without ineffective esophageal motility (IEM), and healthy individuals.
METHODS
Twenty-eight GERD patients and seventeen healthy controls were included. Secondary peristalsis was stimulated by a rapid injection of 20 ml air in mid-esophagus. We compared HRM metrics and the response and effective rate of triggering secondary peristalsis between patients with and without IEM and healthy controls.
RESULTS
Sixteen patients had IEM, and the remaining 12 had normal manometry. By triggering of secondary peristalsis, patients without IEM and healthy controls had significantly higher distal contractile integral (DCI) values than IEM patients (p = 0.006). A successful secondary peristalsis was triggered more frequently in healthy controls than in GERD patients with normal peristalsis or IEM (56.9% vs. 20.2% vs. 9.1%, all p < 0.001). The effective rate which determined as DCI > 450 mm Hg.cm.s was higher in healthy controls compared to patients with normal peristalsis (36.5% vs. 19.4%, p < 0.001) and IEM (36.5% vs. 6.3%, p < 0.001). Patients with IEM had lower successful triggering response (9.1% vs. 20.2%) and effective secondary peristalsis (6.3% vs. 19.4%) compared with patients without IEM (p < 0.001).
CONCLUSIONS
Our work has demonstrated that GERD patients, in particular those with IEM, have significant defects in the triggering of secondary peristalsis on HRM. HRM helps characterize esophageal secondary peristalsis which exhibits differently in patients with and without IEM.
Topics: Adult; Esophageal Motility Disorders; Esophageal pH Monitoring; Female; Gastroesophageal Reflux; Humans; Male; Manometry; Middle Aged; Peristalsis; Prospective Studies
PubMed: 33174275
DOI: 10.1111/nmo.14024 -
Scientific Reports Dec 2020The flow inside the perivascular space (PVS) is modeled using a first-principles approach in order to investigate how the cerebrospinal fluid (CSF) enters the brain...
The flow inside the perivascular space (PVS) is modeled using a first-principles approach in order to investigate how the cerebrospinal fluid (CSF) enters the brain through a permeable layer of glial cells. Lubrication theory is employed to deal with the flow in the thin annular gap of the perivascular space between an impermeable artery and the brain tissue. The artery has an imposed peristaltic deformation and the deformable brain tissue is modeled by means of an elastic Hooke's law. The perivascular flow model is solved numerically, discovering that the peristaltic wave induces a steady streaming to/from the brain which strongly depends on the rigidity and the permeability of the brain tissue. A detailed quantification of the through flow across the glial boundary is obtained for a large parameter space of physiologically relevant conditions. The parameters include the elasticity and permeability of the brain, the curvature of the artery, its length and the amplitude of the peristaltic wave. A steady streaming component of the through flow due to the peristaltic wave is characterized by an in-depth physical analysis and the velocity across the glial layer is found to flow from and to the PVS, depending on the elasticity and permeability of the brain. The through CSF flow velocity is quantified to be of the order of micrometers per seconds.
Topics: Animals; Arteries; Brain; Glymphatic System; Peristalsis; Permeability; Pressure
PubMed: 33273489
DOI: 10.1038/s41598-020-77787-4 -
Biofabrication Oct 2021Peristalsis in the digestive tract is crucial to maintain physiological functions. It remains challenging to mimic the peristaltic microenvironment in gastrointestinal...
Peristalsis in the digestive tract is crucial to maintain physiological functions. It remains challenging to mimic the peristaltic microenvironment in gastrointestinal organoid culture. Here, we present a method to model the peristalsis for human colon tumor organoids on a microfluidic chip. The chip contains hundreds of lateral microwells and a surrounding pressure channel. Human colon tumor organoids growing in the microwell were cyclically contracted by pressure channel, mimicking themechano-stimulus by intestinal muscles. The chip allows the control of peristalsis amplitude and rhythm and the high throughput culture of organoids simultaneously. By applying 8% amplitude with 8 ∼ 10 times min, we observed the enhanced expression of Lgr5 and Ki67. Moreover, ellipticine-loaded polymeric micelles showed reduced uptake in the organoids under peristalsis and resulted in compromised anti-tumor efficacy. The results indicate the importance of mechanical stimuli mimicking the physiological environment when usingmodels to evaluate nanoparticles. This work provides a method for attaining more reliable and representative organoids models in nanomedicine.
Topics: Colonic Neoplasms; Humans; Lab-On-A-Chip Devices; Microfluidics; Organoids; Peristalsis; Tumor Microenvironment
PubMed: 34638112
DOI: 10.1088/1758-5090/ac2ef9 -
Neurogastroenterology and Motility Nov 2021High amplitude peristaltic esophageal contractions, that is, nutcracker esophagus, were originally described in association with "angina-like pain" of esophageal origin....
INTRODUCTION
High amplitude peristaltic esophageal contractions, that is, nutcracker esophagus, were originally described in association with "angina-like pain" of esophageal origin. However, significant number of nutcracker patients also suffer from dysphagia. High-resolution esophageal manometry (HRM) assesses only the contraction phase of peristalsis. The degree of esophageal distension during peristalsis is a surrogate of relaxation and can be measured from the intraluminal esophageal impedance measurements.
AIMS
Determine the amplitude of distension and temporal relationship between distension and contraction during swallow-induced peristalsis in nutcracker patients.
METHODS
HRM impedance (HRMZ) studies were performed and analyzed in 24 nutcracker and 30 normal subjects in the Trendelenburg position. A custom-built software calculated the numerical data of the amplitudes of distension and contraction, the area under the curve (AUC) of distension and contraction, and the temporal relationship between distension and contraction.
RESULTS
In normal subjects, the distension peaks similar to contraction traverse sequentially the esophagus. The amplitude of contraction is greater in the nutcracker esophagus but the amplitude of distension and area under the curve of distension are smaller in patients compared to controls. Distension peaks are aligned closely with contraction in normal subjects, but in patients, the bolus travels faster to the distal esophagus, resulting in a smaller time interval between the onset of swallow and distension peak. Receiver operative characteristics (ROC) curve reveals high sensitivity and specificity of the above parameters in patients.
CONCLUSION
Abnormalities in the distension phase of peristalsis are a possible mechanism of dysphagia in patients with nutcracker esophagus.
Topics: Adult; Aged; Deglutition Disorders; Esophageal Motility Disorders; Female; Humans; Male; Manometry; Middle Aged; Muscle Contraction; Peristalsis; ROC Curve; Young Adult
PubMed: 33818858
DOI: 10.1111/nmo.14138 -
Cell Reports Mar 2020Peristalsis is indispensable for physiological function of the gut. The enteric nervous system (ENS) plays an important role in regulating peristalsis. While the neural...
Peristalsis is indispensable for physiological function of the gut. The enteric nervous system (ENS) plays an important role in regulating peristalsis. While the neural network regulating anterograde peristalsis, which migrates from the oral end to the anal end, is characterized to some extent, retrograde peristalsis remains unresolved with regards to its neural regulation. Using forward genetics in zebrafish, we reveal that a population of neurons expressing a hyperpolarization-activated nucleotide-gated channel HCN4 specifically regulates retrograde peristalsis. When HCN4 channels are blocked by an HCN channel inhibitor or morpholinos blocking the protein expression, retrograde peristalsis is specifically attenuated. Conversely, when HCN4(+) neurons expressing channelrhodopsin are activated by illumination, retrograde peristalsis is enhanced while anterograde peristalsis remains unchanged. We propose that HCN4(+) neurons in the ENS forward activating signals toward the oral end and simultaneously stimulate local circuits regulating the circular muscle.
Topics: Animals; Animals, Genetically Modified; Gastrointestinal Motility; Gastrointestinal Tract; Gene Expression Regulation; Hyperpolarization-Activated Cyclic Nucleotide-Gated Channels; Larva; Morpholinos; Neurons; Optogenetics; Peristalsis; Serotonin; Zebrafish
PubMed: 32130893
DOI: 10.1016/j.celrep.2020.02.024 -
Terapevticheskii Arkhiv May 2018To present application of Chicago classification criteria of esophageal motility disorders defined in high resolution manometry in clinical practice. (Review)
Review
AIM
To present application of Chicago classification criteria of esophageal motility disorders defined in high resolution manometry in clinical practice.
MATERIALS AND METHODS
High-resolution manometry is the most exact hi-tech diagnostic method for esophageal motor function disorders according to Chicago classification v3.0. Uniqueness of the method consists in capacity to define integrated quantitative and qualitative metrics of esophageal contractile function and to establish their specific disorders e.g.: change of intrabolus pressure at disorders of esophagogastric junction (EGj) outflow, hypercontractile esophagus, fragmented contractions and weak or failed peristalsis, distal esophageal spasm. Assessment of the type of achalasia subtypes has significant impact on the patients' treatment choice. According to anatomical location of the lower esophageal sphincter and crural diaphragm several morphological types of gastro-esophageal junction are defined that determine severity of gastroesophageal reflux disease. Multiple rapid swallow responses during esophageal high-resolution manometry reflect esophageal body peristaltic reserve and is a predictor of postoperative complications. Differential diagnosis of belching type became possible at combined application of high-resolution manometry and impedance measurement.
CONCLUSION
High-resolution manometry is a fundamental diagnostic test of esophageal motor function disorders. Clinical application of this method significantly expands diagnostic potential and allows to carry out personalized treatment that increases treatment quality.
Topics: Esophageal Motility Disorders; Gastroesophageal Reflux; Humans; Manometry; Peristalsis
PubMed: 30701897
DOI: 10.26442/terarkh201890593-100