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Neurogastroenterology and Motility Oct 2021Functional luminal imaging probe (FLIP) Panometry assesses the esophageal response to distention and may complement the assessment of primary peristalsis on...
Evaluating esophageal motility beyond primary peristalsis: Assessing esophagogastric junction opening mechanics and secondary peristalsis in patients with normal manometry.
BACKGROUND
Functional luminal imaging probe (FLIP) Panometry assesses the esophageal response to distention and may complement the assessment of primary peristalsis on high-resolution manometry (HRM). We aimed to investigate whether FLIP Panometry provides complementary information in patients with normal esophageal motility on HRM.
METHODS
Adult patients that completed FLIP and had an HRM classification of normal motility were retrospectively identified for inclusion. 16-cm FLIP studies performed during endoscopy were evaluated to assess EGJ distensibility, secondary peristalsis, and identify an abnormal response to distention involving sustained LES contraction (sLESC). Clinical characteristics and esophagram were assessed when available.
KEY RESULTS
Of 164 patients included (mean(SD) age 48(16) years, 75% female), 111 (68%) had normal Panometry with EGJ-distensibility index (DI) ≥2.0 mm /mmHg, maximum EGJ diameter ≥16mm and antegrade contractions. Abnormal EGJ distensibility was observed in 44/164 (27%), and 38/164 (23%) had an abnormal contractile response to distension. sLESC was observed in 11/164 (7%). Among 68 patients that completed esophagram, abnormal EGJ distensibility was more frequently observed with an abnormal esophagram than normal EGJ opening: 14/23 (61%) vs 10/45 (22%); P=0.003. Epiphrenic diverticula were present in 3/164 patients: 2/3 had sLESC.
CONCLUSIONS & INFERENCES
Symptomatic patients with normal esophageal motility on HRM predominantly have normal FLIP Panometry; however, abnormal FLIP findings can be observed. While abnormal Panometry findings appear clinically relevant via an association with abnormal bolus retention, complementary tests, such as provocative maneuvers with HRM and timed barium esophagram, are useful to determine clinical context.
Topics: Adult; Endoscopy, Gastrointestinal; Esophageal Achalasia; Esophagogastric Junction; Female; Humans; Male; Manometry; Middle Aged; Peristalsis; Retrospective Studies
PubMed: 33705590
DOI: 10.1111/nmo.14116 -
World Journal of Gastroenterology Oct 2015Capsule endoscopes have evolved from passively moving diagnostic devices to actively moving systems with potential therapeutic capability. In this review, we will... (Review)
Review
Capsule endoscopes have evolved from passively moving diagnostic devices to actively moving systems with potential therapeutic capability. In this review, we will discuss the state of the art, define the current shortcomings of capsule endoscopy, and address research areas that aim to overcome said shortcomings. Developments in capsule mobility schemes are emphasized in this text, with magnetic actuation being the most promising endeavor. Research groups are working to integrate sensor data and fuse it with robotic control to outperform today's standard invasive procedures, but in a less intrusive manner. With recent advances in areas such as mobility, drug delivery, and therapeutics, we foresee a translation of interventional capsule technology from the bench-top to the clinical setting within the next 10 years.
Topics: Animals; Capsule Endoscopes; Capsule Endoscopy; Drug Delivery Systems; Equipment Design; Humans; Magnetics; Peristalsis; Robotics; Video Recording
PubMed: 26457013
DOI: 10.3748/wjg.v21.i37.10528 -
Postepy Biochemii Mar 2021Constipation occurs more often in old patients, because the intestinal peristalsis decreases with aging. Constipation is caused due to impaired motility of the... (Review)
Review
Constipation occurs more often in old patients, because the intestinal peristalsis decreases with aging. Constipation is caused due to impaired motility of the intestines, intestinal barrier damage and the imbalance between the absorption and secretion of water and electrolytes, as well as disturbed production and release of intestinal hormones, infiltration of the gastrointestinal tract with immune cells, excessive production of pro-inflammatory cytokines and the alterations in the functions of enteric nervous system. In this review we will discuss the most important issues associated with the process of aging of the digestive tract, focusing on the enteric nervous system.
Topics: Aging; Enteric Nervous System; Gastrointestinal Tract; Humans; Peristalsis
PubMed: 34378903
DOI: 10.18388/pb.2021_367 -
Neurogastroenterology and Motility Feb 2022The absence of high-resolution esophageal manometry (HREM) norms in pediatrics limits the assessment of children with dysphagia. This study aimed to describe HREM...
BACKGROUND
The absence of high-resolution esophageal manometry (HREM) norms in pediatrics limits the assessment of children with dysphagia. This study aimed to describe HREM parameters in a cohort of children without dysphagia.
METHODS
Children ages 9-16 years with a negative Mayo Dysphagia Questionnaire screen and normal histologic findings underwent HREM after completion of esophagogastroduodenoscopy. Ten swallows of 5 ml 0.45% saline boluses per subject were captured in supine position. Analyzed data included resting and integrated relaxation pressures (IRP) of lower (LES) and upper (UES) esophageal sphincters, peristaltic contractile integrals, transition zone (TZ) breaks, velocities, and lengths associated with proximal and distal esophagus.
KEY RESULTS
33 subjects (15 female) with mean (range) age 12.9 (9-16) years completed the study. Two of 330 analyzed swallows failed. The UES mean resting pressure, and its 0.2 s and 0.8 s IRPs were 48.3 (95% CI 12.9) mmHg, 2.9 (95% CI 1.9) mmHg, and 12.1 (95% CI 2.5) mmHg, respectively. The LES mean resting pressure and its 4 s IRP were 29.0 (95% CI 4.0) mmHg and 9.2 (95% CI 1.3) mmHg. The mean proximal (PCI) and distal (DCI) esophageal contractile integrals were 231 (95% CI 54.8) mmHg-s-cm and 1789.3 (95% CI 323.5) mmHg-s-cm, with mean TZ break 0.5 (95% CI 0.3) cm.
CONCLUSIONS & INFERENCES
This is the first study to describe HREM parameters in children without dysphagia. Most of the reported measurements were significantly different and less variable from reported adult norms. This emphasizes the need for child-specific catheters, norms, and protocols to define pediatric esophageal motility disorders.
Topics: Adolescent; Adult; Child; Deglutition Disorders; Esophageal Motility Disorders; Female; Humans; Manometry; Peristalsis
PubMed: 34089288
DOI: 10.1111/nmo.14184 -
Gastroenterology Nov 2013High-resolution manometry and recently described analysis algorithms, summarized in the Chicago Classification, have increased the recognition of achalasia. It has... (Review)
Review
High-resolution manometry and recently described analysis algorithms, summarized in the Chicago Classification, have increased the recognition of achalasia. It has become apparent that the cardinal feature of achalasia, impaired lower esophageal sphincter relaxation, can occur in several disease phenotypes: without peristalsis, with premature (spastic) distal esophageal contractions, with panesophageal pressurization, or with peristalsis. Any of these phenotypes could indicate achalasia; however, without a disease-specific biomarker, no manometric pattern is absolutely specific. Laboratory studies indicate that achalasia is an autoimmune disease in which esophageal myenteric neurons are attacked in a cell-mediated and antibody-mediated immune response against an uncertain antigen. This autoimmune response could be related to infection of genetically predisposed subjects with herpes simplex virus 1, although there is substantial heterogeneity among patients. At one end of the spectrum is complete aganglionosis in patients with end-stage or fulminant disease. At the opposite extreme is type III (spastic) achalasia, which has no demonstrated neuronal loss but only impaired inhibitory postganglionic neuron function; it is often associated with accentuated contractility and could be mediated by cytokine-induced alterations in gene expression. Distinct from these extremes is progressive plexopathy, which likely arises from achalasia with preserved peristalsis and then develops into type II achalasia and then type I achalasia. Variations in its extent and rate of progression are likely related to the intensity of the cytotoxic T-cell assault on the myenteric plexus. Moving forward, we need to integrate the knowledge we have gained into treatment paradigms that are specific for individual phenotypes of achalasia and away from the one-size-fits-all approach.
Topics: Algorithms; Disease Progression; Esophageal Achalasia; Humans; Manometry; Muscle Contraction; Muscle Relaxation; Peristalsis; Phenotype
PubMed: 23973923
DOI: 10.1053/j.gastro.2013.08.038 -
Bioinspiration & Biomimetics Mar 2023Peristaltic fluid pumping due to a periodically propagating contraction wave in a vessel fitted with one-way elastic valves is investigated numerically. It is concluded...
Peristaltic fluid pumping due to a periodically propagating contraction wave in a vessel fitted with one-way elastic valves is investigated numerically. It is concluded that the valve spacing within the vessel relative to the contraction wavelength plays a critical role in providing efficient pumping. When the valve spacing does not match the wavelength, the valves open asynchronously and the volume of the vessel segments bounded by two consecutive valves changes periodically, thereby inducing volumetric fluid pumping. The volumetric pumping leads to higher pumping flowrate and efficiency against an adverse pressure gradient. The optimum pumping occurs when the ratio of valve spacing to contraction wavelength is about2/3. This pumping regime is characterized by a longer period during which the valves are open. The results are useful for further understanding the pumping features of lymphatic system and provide insight into the design of biomimetic pumping devices.
Topics: Models, Biological; Peristalsis
PubMed: 36821859
DOI: 10.1088/1748-3190/acbe85 -
Optics Express May 2020Highly sensitive, real-time and label-free sensing of liquid flow in microfluidic environments remains challenging. Here, by growing high-quality graphene directly on a...
Highly sensitive, real-time and label-free sensing of liquid flow in microfluidic environments remains challenging. Here, by growing high-quality graphene directly on a glass substrate, we designed a microfluidic-integrated graphene-based flow sensor (GFS) capable of detecting complex, weak, and transient flow velocity and pressure signals in a microfluidic environment. This device was used to study weak and transient liquid flows, especially blood flow, which is closely related to heart and artery functions. By simulating cardiac peristalsis and arterial flow using peristaltic pumps and microfluidic systems, we monitored simulated arterial blood flow. This ultrasensitive graphene-based flow sensor accurately detected a flow velocity limit as low as 0.7 mm/s, a pumping frequency range of 0.04 Hz to 2.5 Hz, and a pressure range from 0.6 kPa to 14 kPa. By measuring the blood flow velocities and pressures, pathological blood flow signals were distinguished and captured by the corresponding flow velocities or pressures, which can reflect vascular occlusion and heart functions. This sensor may be used for the real-time and label-free monitoring of patients' basic vital signs using their blood flow and provide a possible new method for the care of critically ill patients.
Topics: Arteries; Blood Circulation; Computer Simulation; Computer Systems; Glass; Graphite; Heart; Humans; Microfluidics; Peristalsis; Quartz; Signal Processing, Computer-Assisted; Staining and Labeling
PubMed: 32549478
DOI: 10.1364/OE.392993 -
Cellular and Molecular Life Sciences :... Mar 2007Research in animal models established that tinman, a key gene in Drosophila dorsal vessel development, is an orthologue of Nkx2-5, a key gene in vertebrate cardiac... (Review)
Review
Research in animal models established that tinman, a key gene in Drosophila dorsal vessel development, is an orthologue of Nkx2-5, a key gene in vertebrate cardiac development. Similarities between the arthropod dorsal vessel and vertebrate hearts are interpreted in light of concepts such as homology or convergence. We discuss this controversy in the context of the evolution of animal circulatory pumps and propose the distinction between peristaltic and chambered pumps as a fundamental parameter for evolutionary comparisons between bilaterian pumps. Neither homology nor convergence is satisfactory to explain the origins of hearts and pumping organs. Instead, we propose that animal pumps derive from parallel improvements of an ancestral, peristaltic design represented by a layer of myocytes at the external walls of primitive vessels. This paradigm unifies disparate views, impacts our understanding of bilaterian evolution and may be helpful to interpret similarities between pumping organs of phylogenetically relevant species and emerging models.
Topics: Animals; Biological Evolution; Heart; Humans; Peristalsis; Phylogeny; Sequence Homology, Nucleic Acid
PubMed: 17380312
DOI: 10.1007/s00018-007-6524-1 -
The Journal of Physiology Nov 2006Pyeloureteric peristalsis has long been considered to be triggered by pacemaker atypical smooth muscle cells (SMC) located in the proximal regions of the renal pelvis.... (Review)
Review
Pyeloureteric peristalsis has long been considered to be triggered by pacemaker atypical smooth muscle cells (SMC) located in the proximal regions of the renal pelvis. However, interstitial cells with many of the morphological features and c-Kit immuno-reactivity of interstitial cells of Cajal (ICC), the established pacemaker cells in the intestine, have been demonstrated to be present in small numbers within the ureteropelvic junction (UPJ) of many mammals. Freshly isolated ICC-like cells (ICC-LC) of the mouse UPJ also display autorhyhmicity. This review discusses the notion that ureteric peristalsis depends on the presence of both atypical SMC and ICC-LC which form separate but interconnected networks that drive electrically quiescent typical SMC. In contrast to the intestine or prostate, all regenerative potential discharge in the mouse UPJ is abolished by the L-type Ca(2+) channel blocker nifedipine revealing a fundamental pacemaker signal. Whether these pacemaker transients arise from atypical SMC or ICC-LC or both has yet to be established. We speculate that the presence of spontaneously active ICC-LC in the distal regions of the UPJ maintains rudimentary peristaltic waves and movement of urine towards the bladder after pyeloureteral obstruction or pyeloplasty and disconnection from the proximal pacemaker drive.
Topics: Action Potentials; Animals; Biological Clocks; Calcium; Kidney Pelvis; Mice; Muscle Contraction; Muscle, Smooth; Patch-Clamp Techniques; Peristalsis; Stem Cell Factor; Ureter
PubMed: 16945969
DOI: 10.1113/jphysiol.2006.116855 -
Scientific Reports Jun 2023In a porous medium, we have examined sinusoidal two-dimensional transport enclosed porous peristaltic boundaries having an Eyring Powell fluid with a water containing...
In a porous medium, we have examined sinusoidal two-dimensional transport enclosed porous peristaltic boundaries having an Eyring Powell fluid with a water containing [Formula: see text]. The determining momentum and temperature equations are solved semi-analytically by using regular perturbation method and Mathematica. In present research only free pumping case and small amplitude ratio is studied. Mathematical and pictorial consequences are investigated for distinct physical parameters of interest like porosity, viscosity, volume fraction and permeability to check the effects of flow velocity and temperature.
Topics: Porosity; Peristalsis; Temperature; Viscosity; Motion
PubMed: 37322099
DOI: 10.1038/s41598-023-36136-x