Esophageal multimodal stimulation and sensation

Abstract

Esophageal mechanosensation describes the relationship between a mechanical stimulation of the esophageal wall, such as bag distension, and the reaction to the stimulation perceived or unperceived. When studying mechanosensation in esophageal disease, it is important to recognize that symptoms might be due to alterations at different levels of the neuromuscular system, such as alterations at the mechanoreceptor level or in the afferent mechanosensory pathways, or irregularities in the homeostatic state. One might ask if it is possible to provoke, record, and describe the multidimensional responses behind a mechanosensory experience? It is a complex system and, at a minimum, a multidisciplinary approach is needed to avoid erroneous conclusions. The multimodal study design, taking the mode, location, and parameters of stimulation into consideration, together with controlled recording of assessment parameters, is an approach that seems rational and valid. Gastrointestinal (GI) physicians of the 21th century need to have knowledge of advances in the evaluation of GI mechanical function and what provokes symptoms. Hereby, it is possible to fully appreciate the slowly emerging awareness of how GI pain symptoms should be explored and explained to patients.

Consenso latinoamericano de diagnóstico de la enfermedad por reflujo gastroesofágico

“…El flujo de información aferente desde el esófago hasta la corteza cerebral ocurre a través de diversas neuronas, cada una de ellas susceptible de ser modulada. 7,8 La determinación del grado de sensibilización de un individuo dado es difícil y, habitualmente, en la práctica clínica no están disponibles métodos diagnósticos para medir o confirmar la presencia de hipersensibilidad. En el ámbito clínico, por lo general, se asume que un proceso de hipersensibilidad está contribuyendo a los síntomas si los métodos diagnósticos habituales son negativos para evidencia de reflujo patológico.…”

Diagnosticando la enfermedad por reflujo gastroesofágico en 2022: los cómo y los por qué

“…El flujo de información aferente desde el esófago hasta la corteza cerebral ocurre a través de diversas neuronas, cada una de ellas susceptible de ser modulada. 18,19 La determinación del grado de sensibilización en un individuo dado es difícil y, generalmente, no está disponible en práctica clínica habitual. Dado esto, la separación entre patologías "orgánicas" y "funcionales" es arbitraria.…”

Ultrasound imaging for assessing functions of the GI tract

“…A further development has been the inclusion of an ultrasound miniprobe into multimodal catheters to study biomechanical properties of the esophageal wall (Hoff et al 2018). Hoff and coworkers used an inflatable bag catheter which included manometry proximal to and inside the bag, laser Doppler flowmetry, and an ultrasound miniprobe (figure 1) to measure wall thickness and compliance in patients with unexplained chest pain (Hoff et al 2006).…”