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The Pan African Medical Journal 2018Achalasia, also known as cardiospasm or megaoesophagus is a rare disorder of unknown origin. It is a primary motor disorder of the esophagus characterized by the absence...
Achalasia, also known as cardiospasm or megaoesophagus is a rare disorder of unknown origin. It is a primary motor disorder of the esophagus characterized by the absence of the esophageal peristalsis and by an incomplete or an absent relaxation of the lower oesophageal sphincter. Common symptoms include dysphagia, regurgitations and retrosternal pain. At an advanced level, fibroscopy can show a dilation of the lower esophagus and a shrinkage that can be easily passed through with a lifting at the level of the cardia. Oesogastroduodenal transit shows esophageal dilation and allows to estimate esophageal evacuation speed. Esophageal manometry is the gold standard diagnostic tool because it can show the absence of esophageal body peristalsis, the elevation of lower esophageal sphincter pressure and the absence of complete relaxation of the lower esophageal sphincter during swallowing. The different therapeutic strategies aim to reduce lower oesophageal sphincter pressure. We report the case of a patient with immense extension of the oesophagus with typical achalasia appearance. The patient aged 33 years had capricious low dysphagia evolving since childhood associated with regurgitations and retrosternal pain within a context of a 10kg weight loss. Clinical examination was unremarkable. Oesophagogastroduodenoscopy (OGD) was performed showing very dilated atonic oesophagus with food stasis and very tight cardia easily passed through with a lifting. EGD-transit showed immense dilation of the oesophagus without oesogastric junction abnormality suggesting achalasia. Surgical treatment was recommended.
Topics: Adult; Deglutition Disorders; Esophageal Achalasia; Esophageal Sphincter, Lower; Humans; Male; Manometry; Peristalsis
PubMed: 30061970
DOI: 10.11604/pamj.2018.29.192.4708 -
The Journal of Thoracic and... Dec 2020
Topics: Humans; Lung Transplantation; Peristalsis; Transplants
PubMed: 32197909
DOI: 10.1016/j.jtcvs.2020.02.070 -
American Journal of Physiology.... Mar 2013We investigate flow in the stomach during gastric mixing using a numerical simulation with an anatomically realistic geometry and free-surface flow modeling. Because of...
We investigate flow in the stomach during gastric mixing using a numerical simulation with an anatomically realistic geometry and free-surface flow modeling. Because of momentum differences between greater and lesser curvatures during peristaltic contractions, time-averaged recirculation is generated in the antrum, with retropulsive flow away from the pylorus and compensation flow along the greater curvature toward the pylorus. Gastric content in the distal stomach is continuously transported to the distal antrum by the forward flow of antral recirculation, and it is then mixed by the backward retropulsive flow. Hence, the content inside the antral recirculation is well mixed independently of initial location, whereas the content outside the recirculation is poorly mixed. Free-surface modeling enables us to analyze the effects of posture on gastric mixing. In the upright, prone, and right lateral positions, most of the antrum is filled with content, and the content is well mixed by antral recirculation. In contrast, in the supine and left lateral positions, most of the content is located outside antral recirculation, which results in poor mixing. The curved, twisted shape of the stomach substantially supports gastric mixing in fluid mechanical terms.
Topics: Algorithms; Gastric Emptying; Gastrointestinal Contents; Humans; Models, Anatomic; Peristalsis; Posture; Pyloric Antrum; Stomach
PubMed: 23275619
DOI: 10.1152/ajpgi.00350.2012 -
Nature Communications Dec 2018In vivo vagus nerve stimulation holds great promise in regulating food intake for obesity treatment. Here we present an implanted vagus nerve stimulation system that is...
In vivo vagus nerve stimulation holds great promise in regulating food intake for obesity treatment. Here we present an implanted vagus nerve stimulation system that is battery-free and spontaneously responsive to stomach movement. The vagus nerve stimulation system comprises a flexible and biocompatible nanogenerator that is attached on the surface of stomach. It generates biphasic electric pulses in responsive to the peristalsis of stomach. The electric signals generated by this device can stimulate the vagal afferent fibers to reduce food intake and achieve weight control. This strategy is successfully demonstrated on rat models. Within 100 days, the average body weight is controlled at 350 g, 38% less than the control groups. This work correlates nerve stimulation with targeted organ functionality through a smart, self-responsive system, and demonstrated highly effective weight control. This work also provides a concept in therapeutic technology using artificial nerve signal generated from coordinated body activities.
Topics: 3T3 Cells; Animals; Appetite Regulation; Cell Line; Eating; Mice; Obesity; Peristalsis; Rats; Rats, Sprague-Dawley; Stomach; Vagus Nerve; Vagus Nerve Stimulation
PubMed: 30559435
DOI: 10.1038/s41467-018-07764-z -
Digestion 2021Colonic motility disorders are a frequent clinical problem caused by various drugs and diseases. However, the etiology of colonic dysmotility is often unclear due to the...
INTRODUCTION
Colonic motility disorders are a frequent clinical problem caused by various drugs and diseases. However, the etiology of colonic dysmotility is often unclear due to the lack of in vivo methods, including rapid dynamic assessment.
OBJECTIVES
The aim of this study was to establish a novel quantitative method to objectively assess colonic motility using ultrasonography.
METHODS
We applied echocardiographic speckle tracking-based strain imaging to analyze murine colonic motility. A trace line was placed on the boundary between the proximal wall of the colon and the inner cavity to analyze colonic wall displacement and strain rate. Locomotion activities of the colonic wall were used to quantify colonic motility via ultrasonography.
RESULTS
We found that ultrasonography can quantitatively detect a decrease in colonic motility induced by loperamide, an antidiarrheal drug. These quantitative data were consistent with the imaging findings of colonic peristalsis and colon transit time. Additionally, ultrasonography also revealed changes in colonic motility over short intervals. Furthermore, we have shown that ultrasonography can quantitatively and noninvasively detect colonic dysmotility and hypervascularity of the colonic wall in colitis mice.
CONCLUSIONS
These findings suggest that ultrasonography is a useful in vivo method for objectively monitoring changes in colonic motility caused by drugs and diseases.
Topics: Animals; Colitis; Colon; Gastrointestinal Motility; Mice; Peristalsis; Ultrasonography
PubMed: 33260180
DOI: 10.1159/000511851 -
Arquivos de Gastroenterologia Apr 2013Supragastric belches are the main determinants of troublesome belching symptoms. In supragastric belches, air is rapidly brought into the esophagus and is immediately...
CONTEXT
Supragastric belches are the main determinants of troublesome belching symptoms. In supragastric belches, air is rapidly brought into the esophagus and is immediately followed by a rapid expulsion before it has reached the stomach.
OBJECTIVE
To evaluate the esophageal contraction and transit after wet swallows in patients with troublesome belching.
METHODS
Esophageal contraction and transit were evaluated in 16 patients with troublesome belching and 15 controls. They were measured at 5, 10, 15, and 20 cm from the lower esophageal sphincter (LES) by a solid state manometric and impedance catheter. Each subject swallowed five 5 mL boluses of saline.
RESULTS
The amplitude, duration and area under the curve of contractions were similar in patients with troublesome belching and control subjects. The total esophageal bolus transit time was 6.2 (1.8) s in patients with troublesome belching and 6.1 (2.3) s in controls (P=0.55). The bolus presence time was longer in controls than in patients at 5 cm from the LES [controls: 6.0 (1.1) s, patients: 4.9 (1.2) s, P=0.04], without differences at 10, 15 and 20 cm from the LES. The bolus head advanced time was longer in patients than controls from 20 cm to 15 cm [controls: 0.1 (0.1) s, patients: 0.7(0.8)s, P=0.01] and from 15 cm to 10 cm [controls: 0.3 (0.1) s, patients: 1.6 (2.6) s, P=0.01] of the LES, without difference from 10 cm to 5 cm [controls: 0.7 (0.3) s, patients: 1.0 (1.1) s, P=0.37]. There was no difference in segment transit time.
CONCLUSION
There was no difference in esophageal contractions between patients with troublesome belching and controls. The swallowed bolus went slower into the proximal and middle esophageal body in patients than in control, but cross the distal esophageal body faster in patients than in controls.
Topics: Adult; Case-Control Studies; Electric Impedance; Eructation; Esophagus; Female; Humans; Male; Manometry; Middle Aged; Peristalsis
PubMed: 23903619
DOI: 10.1590/s0004-28032013000200017 -
Neurogastroenterology and Motility Feb 2020Association between proportions of hypomotile swallows on esophageal high-resolution manometry (HRM) and esophageal reflux burden remains incompletely understood. We... (Observational Study)
Observational Study
BACKGROUND
Association between proportions of hypomotile swallows on esophageal high-resolution manometry (HRM) and esophageal reflux burden remains incompletely understood. We investigated relationships between hypomotility, acid exposure time (AET), and mean nocturnal baseline impedance (MNBI) on ambulatory reflux monitoring.
METHODS
Clinical data, HRM, and ambulatory pH-impedance studies (performed off acid suppression) from patients with persisting reflux symptoms were reviewed from five international centers. AET (abnormal > 6%) and MNBI (abnormal < 2292 ohms) were extracted from pH-impedance studies. Distal contractile integral (DCI) designated esophageal peristalsis into normal (DCI > 450 mmHg.cm.s), fragmented (DCI > 450 mmHg.cm.s with breaks > 5 cm), weak (DCI 100-450 mmHg.cm.s), and failed (DCI < 100 mm mmHg.cm.s) sequences. Univariate and multivariate analyses were performed to identify motor associations of abnormal reflux burden.
KEY RESULTS
Of 351 patients (52.1 ± 0.8 years, 67%F), 29.3% had AET > 6% and 61.8% had MNBI < 2292 ohms. On univariate analysis, both fragmented peristalsis and IEM associated with abnormal AET (P ≤ .01) and MNBI (P ≤ .03); reflux burden was more profound with >70% fragmented as well as ineffective sequences compared to ≤70% for each (P < .05 for each comparison). When weak and failed sequences within IEM were separately analyzed, ≥50% failed sequences predicted abnormal AET (P ≤ .009), and ≥50% weak sequences did not (P = .14). On multivariate regression, ≥50% failed sequences predicted abnormal AET (P = .02), and >70% ineffective sequences trended strongly (P = .069); >70% ineffective sequences predicted abnormal MNBI (P = .046), and >70% fragmented sequences trended strongly (P = .076).
CONCLUSIONS AND INFERENCES
Breaks in esophageal peristaltic integrity seen with fragmented and failed sequences are more relevant to abnormal esophageal acid burden than weak sequences.
Topics: Deglutition; Esophageal pH Monitoring; Female; Gastroesophageal Reflux; Humans; Male; Manometry; Middle Aged; Peristalsis; Retrospective Studies
PubMed: 31574208
DOI: 10.1111/nmo.13736 -
Magnetic Resonance in Medical Sciences... 2005We evaluated esophageal peristalsis in patients with esophageal tumors by cine MR using steady-state free precession (SSFP) sequence and correlated the alteration of the...
We evaluated esophageal peristalsis in patients with esophageal tumors by cine MR using steady-state free precession (SSFP) sequence and correlated the alteration of the esophageal peristalsis with clinical symptoms and tumor stages. Thirteen patients with pathologically proven esophageal tumors, including 12 esophageal cancers and one submucosal leiomyoma, underwent cine MRI using true fast imaging with steady precession (trueFISP) sequence, which is one SSFP sequence, after contrast-enhanced MR scanning for clinical purposes. A total of 120 serial images were obtained within 60 s through the plane along the long axis of the esophagus while patients chewed gum. The serial trueFISP images were evaluated for the presence, frequency, speed of progression, and passage of peristalsis through the tumor. The data from cine MRI were compared with clinical symptoms and tumor stages. Peristalsis was clearly identified in all patients. Seven patients with complete interruption of peristalsis had dysphagia; one with partially impaired peristalsis could intake solid foods with discomfort; and two with partially impaired peristalsis and three with preserved peristalsis remained asymptomatic. Patients with complete or partial interruption of peristalsis had Stage T3 or T4 esophageal cancer. In conclusion, trueFISP cine MR imaging enables direct visualization of esophageal peristalsis in relation to esophageal tumors. Complete interruption of peristalsis causes dysphagia, whereas partial interruption of and preserved peristalsis usually do not cause digestive problems. Interruption of peristalsis may indicate impaired muscle function caused by invasion of advanced esophageal cancers.
Topics: Esophageal Neoplasms; Esophagus; Humans; Magnetic Resonance Imaging, Cine; Male; Mastication; Middle Aged; Neoplasm Staging; Peristalsis
PubMed: 16462130
DOI: 10.2463/mrms.4.109 -
American Journal of Physiology.... Feb 2019The aims of this study were to 1) examine pharyngoesophageal and cardiorespiratory responses to provoking pharyngeal stimuli, and 2) to determine potential contributory...
The aims of this study were to 1) examine pharyngoesophageal and cardiorespiratory responses to provoking pharyngeal stimuli, and 2) to determine potential contributory factors impacting heart rate (HR) changes to provide insight into cardiorespiratory events occurring in preterm infants. Forty-eight neonates (19 females and 29 males, born at 27.7 ± 0.5 wk; mean ± SE) pending discharge on full oral feeds were studied at 38.7 ± 0.2 wk postmenstrual age using concurrent pharyngoesophageal manometry, electrocardiography, respiratory inductance plethysmography, and nasal airflow thermistor. Pharyngoesophageal and cardiorespiratory responses (prevalence, latency, and duration) were quantified upon abrupt pharyngeal water stimuli (0.1, 0.3, and 0.5 ml in triplicate). Mixed linear models and generalized estimating equations were used for comparisons between HR changes. Contributory factors included stimulus characteristics and subject characteristics. Of 338 pharyngeal stimuli administered, HR increased in 23 (7%), decreased in 108 (32%), and remained stable in 207 (61%) neonates. HR decrease resulted in repetitive swallowing, increased respiratory-rhythm disturbance, and decreased esophageal propagation rates (all, P < 0.05). HR responses were related to stimulus volume, stimulus flow rate, and extreme prematurity (all, P < 0.05). In preterm infants, HR remains stable in a majority of pharyngeal provocations. HR decrease, due to pharyngeal stimulation, is related to aberrant pharyngoesophageal motility and respiratory dysregulation and is magnified by prematurity. We infer that the observed aberrant responses across digestive, respiratory, and cardiovascular systems are related to maladaptive maturation of the parasympathetic nervous system. These aberrant responses may provide diagnostic clues for risk stratification of infants with troublesome cardiorespiratory events and swallowing difficulty. NEW & NOTEWORTHY Cardiorespiratory rhythms concurrent with pharyngeal, upper esophageal sphincter, and esophageal body responses were examined upon pharyngeal provocation in preterm-born infants who were studied at full-term maturation. Decreased heart rate (HR) was associated with extreme preterm birth and stimulus flow/volume. With HR decrease responses, aerodigestive reflex abnormalities were present, characterized by prolonged respiratory rhythm disturbance, repetitive multiple swallowing, and poor esophageal propagation. Promoting esophageal peristalsis may be a potential therapeutic target.
Topics: Deglutition; Deglutition Disorders; Esophageal Sphincter, Upper; Female; Humans; Infant, Premature; Male; Manometry; Peristalsis; Plethysmography; Respiration; Risk
PubMed: 30543445
DOI: 10.1152/ajpgi.00303.2018 -
Pediatric Research Aug 2014Aero-digestive morbidities are common in congenital heart disease infants, and the mechanisms are unclear. We hypothesized that adaptive pharyngoesophageal motility...
BACKGROUND
Aero-digestive morbidities are common in congenital heart disease infants, and the mechanisms are unclear. We hypothesized that adaptive pharyngoesophageal motility reflexes are different in surgical congenital heart disease infants (S-CHD) vs. nonsurgical congenital heart disease infants (CHD) and healthy controls.
METHODS
Abrupt pharyngeal provocation was performed with graded water infusions using purpose-built micromanometry. The data from 12 S-CHD were compared with data from 10 CHD and 12 controls. One hundred and ninety-seven water stimulations were examined for the frequency, latency, duration, and magnitude of pharyngo-upper esophageal sphincter contractile response (PUCR), pharyngeal reflexive swallow (PRS), esophageal body peristalsis, and lower esophageal sphincter (LES) relaxation characteristics. Mixed statistical models were applied.
RESULTS
Frequency distribution (%) of PUCR: PRS: none in S-CHD vs. CHD vs. controls, respectively, were 36:46:17 vs. 9:80:11 vs. 15:61:24 (P < 0.05). Response latency to the final esophageal body waveform (P = 0.01) and the response duration of esophageal body peristalsis (P = 0.04) were prolonged in S-CHD vs. controls but were similar to CHD (P = 0.22). Pharyngeal infusion-induced LES relaxation characteristics were similar in all three groups.
CONCLUSION
Abnormality in the recruitment of PUCR or PRS reflexes and esophageal body peristalsis in S-CHD implicate dysregulation in vagal cholinergic excitatory neuromotor responses.
Topics: Analysis of Variance; Deglutition; Deglutition Disorders; Female; Gastrointestinal Motility; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Male; Manometry; Muscle Contraction; Peristalsis; Water
PubMed: 24819378
DOI: 10.1038/pr.2014.68