Functional Anatomy and Physiology of Swallowing and Esophageal Motility

Rengarajan, Arvind; Gyawali, C. Prakash

doi:10.1002/9781119599692.ch5

Cited by 4 publications

(3 citation statements)

References 312 publications

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“…In normal esophageal physiology, a peristaltic wave after swallowing is formed as a result of coordinated, antegrade esophageal circular muscle contractions in conjunction with longitudinal muscle shortening acts which acts to propel liquid and/or solid content toward the stomach. [16][17][18] In type 3 achalasia, circular muscle contraction is non-peristaltic, resulting in circular muscle spasticity and luminal obstruction after swallowing. [3][4][5] POEM is the ideal treatment for type 3 achalasia as the circular muscle myotomy can be extended proximally along the entire length of the spastic muscle segment.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic methods to measure spastic segment and guide tailored myotomy length in type 3 achalasia

Low

Hasan

Fehmi

et al. 2023

Neurogastroenterology Motil

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BackgroundMyotomy length in type 3 achalasia is generally tailored based on segment of spasticity on high‐resolution manometry (HRM). Potential of length of tertiary contractions on barium esophagram (BE) or length of thickened circular muscle on endoscopic ultrasound (EUS) to guide tailored myotomy is less understood. This study aimed to assess agreement between spastic segments lengths on HRM, BE, and EUS among patients with type 3 achalasia.MethodsThis retrospective study included adults with type 3 achalasia on HRM between November 2019 and August 2022 who underwent evaluation with EUS and/or BE. Spastic segments were defined as HRM—distance between proximal borders of lower esophageal sphincter and high‐pressure area (isobaric contour ≥70 mmHg); EUS—length of thickened circular muscle (≥1.2 mm) from proximal border of esophagogastric junction (EGJ) to the transition to a non‐thickened circular muscle; BE—distance between EGJ to proximal border of tertiary contractions. Pairwise comparisons assessed for correlation (Pearson's) and intraclass correlation classification (ICC) agreement.Key ResultsTwenty‐six patients were included: mean age 66.9 years (SD 13.8), 15 (57.7%) male. Spastic segments were positively correlated on HRM and BE with good agreement (ICC 0.751, [95% CI 0.51, 0.88]). Spastic segments were negatively correlated with poor agreement on HRM and EUS (ICC −0.04, [−0.45, 0.39]) as well as BE and EUS (ICC −0.03, [−0.47, 0.42]).Conclusions & InferencesLength of spastic segment was positively correlated on HRM and BE while negatively correlated when compared to EUS, supporting the common use of HRM and highlighting the uncertain role for EUS in tailoring myotomy length for type 3 achalasia.

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Section: Discussionmentioning

confidence: 99%

Diagnostic methods to measure spastic segment and guide tailored myotomy length in type 3 achalasia

Low

Hasan

Fehmi

et al. 2023

Neurogastroenterology Motil

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“…The abdominal portion of either the esophagus is situated on the dorsal border to that of the left liver lobe in the esophageal impression. Lower esophageal sphincter muscles at either the ends of the esophagus, but there is no clear anatomical demarcation of the limits of the sphincters [24].…”

Section: Gross Anatomy Of the Esophagusmentioning

confidence: 99%

Esophagus

AL-Taai¹

2022

Pharynx - The Incredible Rendezvous Sites of Gas, Liquid and Solid

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The manuscript aims to include gross anatomical and histological structure of the esophagus. The esophagus is one of the important portions of the digestive system. Definition of the esophagus is, a muscular tube which is extended from the pharynx floor until the stomach. Its function is to transport the food particles from the oropharynx by swallowing operation on way esophageal opening during pharynx to the stomach. Morphology, the esophagus is a long cylindrical structure, which is divided into three segments, the upper portion is called cervical, either intermediate is the thoracic part, and the lower segment is named abdominal, which is attached with the stomach. Muscles of the esophagus are skeletal or striated muscles in the upper segment toward the pharynx, striated and smooth in the middle, either latest segment of the esophagus consists of smooth muscles only. The esophageal structure is different from other types of animals. These differences depend on the nature of food consumption. Histology, the esophagus contains four layers called tunics. First tunics is called the mucosa (epithelia have stratified squamous non-keratin, lamina properia, and muscularis), the next tunics is sub mucosa (connective tissue) with spread to find esophageal glands, either the other two layers are tunica muscularis (outer layer included longitudinal orientation and inner muscles is circular orientations), circular muscle orientation is not clearly circular in each part of the esophagus, but these fibers become more actually at lower parts of the esophagus. Either the muscularis and adventitia (loose connective tissue) without being covered by mesothelium.

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“…The muscles of the esophagus relax and respiration resumes as the UES contracts to separate the bolus in the esophagus from the pharynx and the airways. Activation of the swallowing center influences the activities of other centers, most notably the respiratory center, as is evidenced by a physiologic apneic pause of 0.5 to 3.5 seconds that accompanies every swallow (21). Apnea occurs also during belching and vomiting.…”

Section: Swallowing and Peristalsismentioning

confidence: 99%

Mechanisms of Gastroesophageal Reflux and Gastroesophageal Reflux Disease

Vandenplas,

Hassall

2002

J. pediatr. gastroenterol. nutr.

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Gastroesophageal reflux is a physiological phenomenon, occurring with different severity and duration in different individuals. Reflux disease occurs when this normal event results in the occurrence of symptoms/signs or complications. The pathophysiology of gastroesophageal reflux is complex and diverse, since it is influenced by factors that are genetic, environmental (e.g., diet smoking), anatomic, hormonal, and neurogenic. However, many mechanisms remain incompletely understood. Future research should focus on a better understanding of the physiology of the upper and lower esophageal sphincters, and of gastric motility. The afferent and efferent neural pathways and neuropharmacologic mediators of transient lower esophageal sphincter relaxations and gastric dysmotility require further study. The role of anatomic malformations such as hiatal hernia in children has been underestimated.While therapeutic possibilities are greater in number and largely improved, the outcomes of some treatments are far from satisfactory in many cases. In addition to development of new forms of treatment, research should address better use of currently available medical and surgical treatments.

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Functional Anatomy and Physiology of Swallowing and Esophageal Motility

Cited by 4 publications

References 312 publications

Diagnostic methods to measure spastic segment and guide tailored myotomy length in type 3 achalasia

Diagnostic methods to measure spastic segment and guide tailored myotomy length in type 3 achalasia

Esophagus

Mechanisms of Gastroesophageal Reflux and Gastroesophageal Reflux Disease

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