Defining lower esophageal sphincter physiomechanical states among esophageal motility disorders using functional lumen imaging probe panometry.
achalasia
esophageal motility
functional lumen imaging probe (FLIP)
lower esophageal sphincter
manometry
Journal
Neurogastroenterology and motility
ISSN: 1365-2982
Titre abrégé: Neurogastroenterol Motil
Pays: England
ID NLM: 9432572
Informations de publication
Date de publication:
02 Sep 2024
02 Sep 2024
Historique:
revised:
19
07
2024
received:
02
05
2024
accepted:
18
08
2024
medline:
3
9
2024
pubmed:
3
9
2024
entrez:
3
9
2024
Statut:
aheadofprint
Résumé
Functional lumen imaging probe (FLIP) panometry assesses esophageal motility in response to controlled volumetric distension. This study aimed to describe the physiomechanical states of the lower esophageal sphincter (LES) in response to serial filling/emptying regimes for esophageal motility disorders. Fourty-five patients with absent contractile response on FLIP and diagnoses of normal motility (n = 6), ineffective esophageal motility (IEM; n = 8), scleroderma (SSc; n = 10), or nonspastic achalasia (n = 21) were included, as were 20 patient controls with normal motility on FLIP and manometry. LES diameter and pressure were measured after stepwise FLIP filling at 60 mL, 70 mL, and emptying to 60 mL with relative changes used to define physiomechanical states. Passive dilatation after FLIP filling occurred in 63/65 (97%) patients among all diagnoses. After FLIP emptying, passive shortening occurred in 12/14 (86%) normal motility/IEM, 10/10 (100%) SSc, 9/21(43%) achalasia, and 16/20 (80%) controls, with auxotonic relaxation seen in 2/14 (14%) normal motility/IEM, 12/21 (57%) achalasia, and 4/20 (20%) controls. After achalasia treatment (LES myotomy), 21/21 (100%) achalasia had passive shortening after FLIP emptying. Physiomechanical states of the LES can be determined via response to FLIP filling and emptying regimes. While passive shortening was the general response to FLIP emptying, auxotonic relaxation was observed in achalasia, which was disrupted by LES myotomy. Further investigation is warranted into the clinical impact on diagnosis and treatment of esophageal motility disorders.
Sections du résumé
BACKGROUND
BACKGROUND
Functional lumen imaging probe (FLIP) panometry assesses esophageal motility in response to controlled volumetric distension. This study aimed to describe the physiomechanical states of the lower esophageal sphincter (LES) in response to serial filling/emptying regimes for esophageal motility disorders.
METHODS
METHODS
Fourty-five patients with absent contractile response on FLIP and diagnoses of normal motility (n = 6), ineffective esophageal motility (IEM; n = 8), scleroderma (SSc; n = 10), or nonspastic achalasia (n = 21) were included, as were 20 patient controls with normal motility on FLIP and manometry. LES diameter and pressure were measured after stepwise FLIP filling at 60 mL, 70 mL, and emptying to 60 mL with relative changes used to define physiomechanical states.
KEY RESULTS
RESULTS
Passive dilatation after FLIP filling occurred in 63/65 (97%) patients among all diagnoses. After FLIP emptying, passive shortening occurred in 12/14 (86%) normal motility/IEM, 10/10 (100%) SSc, 9/21(43%) achalasia, and 16/20 (80%) controls, with auxotonic relaxation seen in 2/14 (14%) normal motility/IEM, 12/21 (57%) achalasia, and 4/20 (20%) controls. After achalasia treatment (LES myotomy), 21/21 (100%) achalasia had passive shortening after FLIP emptying.
CONCLUSIONS & INFERENCES
CONCLUSIONS
Physiomechanical states of the LES can be determined via response to FLIP filling and emptying regimes. While passive shortening was the general response to FLIP emptying, auxotonic relaxation was observed in achalasia, which was disrupted by LES myotomy. Further investigation is warranted into the clinical impact on diagnosis and treatment of esophageal motility disorders.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14906Subventions
Organisme : U.S. Public Health Service
Informations de copyright
© 2024 The Author(s). Neurogastroenterology & Motility published by John Wiley & Sons Ltd.
Références
Carlson DA, Lin Z, Rogers MC, Lin CY, Kahrilas PJ, Pandolfino JE. Utilizing functional lumen imaging probe topography to evaluate esophageal contractility during volumetric distention: a pilot study. Neurogastroenterol Motil. 2015;27(7):981‐989.
McMahon BP, Frokjaer JB, Kunwald P, et al. The functional lumen imaging probe (FLIP) for evaluation of the esophagogastric junction. Am J Physiol Gastrointest Liver Physiol. 2007;292(1):G377‐G384.
Carlson DA, Gyawali CP, Khan A, et al. Classifying esophageal motility by FLIP panometry: a study of 722 subjects with Manometry. Am J Gastroenterol. 2021;116(12):2357‐2366.
Carlson DA, Hirano I, Gonsalves N, et al. A Physiomechanical model of esophageal function in eosinophilic esophagitis. Gastroenterology. 2023;165:552‐563.e4.
Carlson DA, Baumann AJ, Donnan EN, Krause A, Kou W, Pandolfino JE. Evaluating esophageal motility beyond primary peristalsis: assessing esophagogastric junction opening mechanics and secondary peristalsis in patients with normal manometry. Neurogastroenterol Motil. 2021;33:e14116.
Carlson DA, Schauer JM, Kou W, Kahrilas PJ, Pandolfino JE. FLIP Panometry helps identify clinically relevant esophagogastric junction outflow obstruction per Chicago classification v4.0. Am J Gastroenterol. 2023;118:77‐86.
Wakim El‐Khoury J, Pandolfino JE, Kahrilas PJ, et al. Relaxation of the lower esophageal sphincter in response to reduced volume distension during FLIP Panometry. Neurogastroenterol Motil. 2023;35(11):e14663.
Costa M, Wiklendt L, Arkwright JW, et al. An experimental method to identify neurogenic and myogenic active mechanical states of intestinal motility. Front Syst Neurosci. 2013;7:7.
Aziz Q, Fass R, Gyawali CP, Miwa H, Pandolfino JE, Zerbib F. Functional esophageal disorders. Gastroenterology. 2016;150:1368‐1379.
Carlson DA, Kahrilas PJ, Lin Z, et al. Evaluation of esophageal motility utilizing the functional lumen imaging probe. Am J Gastroenterol. 2016;111(12):1726‐1735.
Carlson DA, Kou W, Lin Z, et al. Normal values of esophageal Distensibility and distension‐induced contractility measured by functional luminal imaging probe Panometry. Clin Gastroenterol Hepatol. 2019;17(4):674‐681 e1.
Kraichely RE, Arora AS, Murray JA. Opiate‐induced oesophageal dysmotility. Aliment Pharmacol Ther. 2010;31(5):601‐606.
Yadlapati R, Kahrilas PJ, Fox MR, et al. Esophageal motility disorders on high‐resolution manometry: Chicago classification version 4.0©. Neurogastroenterol Motil. 2021;33(1):e14058.
Eckardt VF, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology. 1992;103(6):1732‐1738.
de Oliveira JM, Birgisson S, Doinoff C, et al. Timed barium swallow: a simple technique for evaluating esophageal emptying in patients with achalasia. AJR Am J Roentgenol. 1997;169(2):473‐479.
Leibbrandt RE, Dinning PG, Costa M, et al. Characterization of esophageal physiology using mechanical state analysis. Front Syst Neurosci. 2016;10:10.
Cock C, Leibbrandt RE, Dinning PG, Costa MC, Wiklendt L, Omari TI. Changes in specific esophageal neuromechanical wall states are associated with conscious awareness of a solid swallowed bolus in healthy subjects. Am J Physiol Gastrointest Liver Physiol. 2020;318(5):G946‐G954.
Omari TI, Jones CA, Hammer MJ, et al. Predicting the activation states of the muscles governing upper esophageal sphincter relaxation and opening. Am J Physiol Gastrointest Liver Physiol. 2016;310(6):G359‐G366.
Lang IM, Medda BK, Shaker R. Mechanisms of reflexes induced by esophageal distension. Am J Physiol Gastrointest Liver Physiol. 2001;281(5):G1246‐G1263.
Paterson WG, Rattan S, Goyal RK. Esophageal responses to transient and sustained esophageal distension. Am J Phys. 1988;255(5 Pt 1):G587‐G595.
Sifrim D, Janssens J. Secondary peristaltic contractions, like primary peristalsis, are preceded by inhibition in the human esophageal body. Digestion. 1996;57(1):73‐78.
Carlson DA, Prescott JE, Baumann AJ, et al. Validation of clinically relevant thresholds of Esophagogastric junction obstruction using FLIP Panometry. Clin Gastroenterol Hepatol. 2022;20(6):e1250‐e1262.
Sodikoff JB, Lo AA, Shetuni BB, Kahrilas PJ, Yang GY, Pandolfino JE. Histopathologic patterns among achalasia subtypes. Neurogastroenterol Motil. 2016;28(1):139‐145.