Regulation and dysregulation of esophageal peristalsis by the integrated function of circular and longitudinal muscle layers in health and disease

Mittal, Ravinder K.

doi:10.1152/ajpgi.00182.2016

Cited by 46 publications

(29 citation statements)

References 95 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition, stretch‐activated relaxation and contraction are mediated through mechanosensitive neurons located in the myenteric plexus . Circular muscle contraction, esophageal shortening (from longitudinal muscle contraction), and esophageal muscle tone participate in normal esophageal peristalsis under cholinergic and nitrergic neural control …”

Section: Pathophysiologic Conceptsmentioning

confidence: 99%

Ineffective esophageal motility: Concepts, future directions, and conclusions from the Stanford 2018 symposium

Gyawali

Sifrim

Carlson

et al. 2019

Neurogastroenterology Motil

View full text Add to dashboard Cite

Background Ineffective esophageal motility (IEM) is a heterogenous minor motility disorder diagnosed when ≥50% ineffective peristaltic sequences (distal contractile integral <450 mm Hg cm s) coexist with normal lower esophageal sphincter relaxation (integrated relaxation pressure < upper limit of normal) on esophageal high‐resolution manometry (HRM). Ineffective esophageal motility is not consistently related to disease states or symptoms and may be seen in asymptomatic healthy individuals. Purpose A 1‐day symposium of esophageal experts reviewed existing literature on IEM, and this review represents the conclusions from the symposium. Severe IEM (>70% ineffective sequences) is associated with higher esophageal reflux burden, particularly while supine, but milder variants do not progress over time or consistently impact quality of life. Ineffective esophageal motility can be further characterized using provocative maneuvers during HRM, especially multiple rapid swallows, where augmentation of smooth muscle contraction defines contraction reserve. The presence of contraction reserve may predict better prognosis, lesser reflux burden and confidence in a standard fundoplication for surgical management of reflux. Other provocative maneuvers (solid swallows, standardized test meal, rapid drink challenge) are useful to characterize bolus transit in IEM. No effective pharmacotherapy exists, and current managements target symptoms and concurrent reflux. Novel testing modalities (baseline and mucosal impedance, functional lumen imaging probe) show promise in elucidating pathophysiology and stratifying IEM phenotypes. Specific prokinetic agents targeting esophageal smooth muscle need to be developed for precision management.

show abstract

Section: Pathophysiologic Conceptsmentioning

confidence: 99%

Ineffective esophageal motility: Concepts, future directions, and conclusions from the Stanford 2018 symposium

Gyawali

Sifrim

Carlson

et al. 2019

Neurogastroenterology Motil

View full text Add to dashboard Cite

show abstract

“…During TLESR, esophageal shortening often occurs by much stronger contraction of the longitudinal muscle than circular muscle. The discordance of these two muscle layers stretches myenteric neurons to release nitric oxide, which is possibly involved with the mechanism of TLESR [ 9 ].…”

Section: Two Types Of Belching: Gastric Belching and Supragastric mentioning

confidence: 99%

Belching in Gastroesophageal Reflux Disease: Literature Review

Fujiwara

Sifrim

2020

JCM

View full text Add to dashboard Cite

Belching is a common phenomenon. However, it becomes bothersome if excessive. Impedance–pH monitoring can classify the belching into two types: gastric belching and supragastric belching (SGB). The former is a physiological mechanism to vent swallowed air from the stomach, whereas the latter is a behavioral disorder. Gastroesophageal reflux disease (GERD) is the most relevant condition in both types of belching. Recent findings have raised awareness that excessive SGB possibly sheds light on the pathogenesis of a part of proton pump inhibitor (PPI) refractoriness in GERD. SGB could cause typical reflux symptoms such as heartburn, regurgitation or chest pain in two ways: SGB-induced gastroesophageal reflux or SGB-induced esophageal distension. In PPI-refractory GERD, it is important to detect hidden SGB as a cause of reflux symptoms since SGB requires psychological treatment instead of high dose PPIs or pain modulators. In the case of PPI-refractory GERD with excessive SGB, recent studies imply that the combination of a psychological approach and conventional treatment can improve treatment outcome.

show abstract

“…Esophageal distension in‐vivo can reveal abnormal intramural motor patterns in dysphagic patients with otherwise normal primary peristalsis 34 . Contractile decoupling and selective contractile dysfunction(s) of the circular and longitudinal muscle layers are reported in various disorders 35 and may perturb the normal ability of the esophagus to biomechanically distend 35 . Hence, contractile decoupling can produce a motor pattern suggestive of impaired inhibition, even though the inhibitory apparatus is functioning normally.…”

Section: Discussionmentioning

confidence: 99%

A study of dysphagia symptoms and esophageal body function in children undergoing anti‐reflux surgery

et al. 2018

View full text Add to dashboard Cite

Abstract:Background & Aims: The role of high resolution esophageal impedance manometry (HRIM) for establishing risk for dysphagia after anti-reflux surgery is unclear. We conducted a prospective study of children with primary GER disease, for whom symptoms of dysphagia to solids were determined pre-and post-operatively and we examined for features that may predict post-operative dysphagia. Methods: Thirteen children (aged 6.8 -15.5 years) undergoing work up prior to 360o Nissen fundoplication were included. A dysphagia score assessed symptoms. A HRIM procedure recorded 5ml liquid, 5ml viscous and 2cm solid boluses. We assessed esophageal motility, esophago-gastric junction (EGJ) morphology, EGJ contractility and pressure-flow variables indicative of bolus distension pressures and bolus clearance pressures. A composite pressure-flow-index score (PFI) was also derived. Results: Pre-operative PFI was positively correlated with post-operative dysphagia score (PFI viscous bolus r = 0.771, p<0.005 Abbreviations: HRIM, high resolution impedance manometry; GER, gastroesophageal reflux; EGJ, esophago-gastric junction; LES, lower esophageal sphincter; CD, crural diaphragm; TZ, transition zone; CDP, contractile deceleration point; pH-MII, pH with multichannel intraluminal impedance; PPI, proton pump inhibitor; EPT, esophageal pressure topography; IRP4s, 4s integrated relaxation pressure; CFV, contractile front velocity; DCI, distal contractile integral; DL, distal latency; EGJ-CI, EGJ contractile index; DPA, distension pressure during bolus accommodation; DPCT, distension pressure during compartmentalized transport; DPE, distension pressure during esophageal emptying; PFI, pressure-flow-index; IR, impedance ratio; SDL, swallow to distension latency; DCL, distension to contraction latency; RP, ramp pressure; IEM, ineffective esophageal motility; EoE, eosinophilic esophagitis. Acknowledgements:We thank Mrs G Seiboth, Mrs K Lowe and Ms S Kritas for assistance with performance of HRIM studies and Dr Junko Fujino for assistance with reviewing endoscopy images. • The ability to accurately predict post-operative dysphagia risk is of interest to gastroenterologists. 'Pressure-flow' anomalies may be predictors of dysphagia symptoms following anti-reflux surgery.• Past studies were performed using 'low-resolution' perfusion lower esophageal sphincter sleeve-manometry.2. What are the significant and/or new findings of this study?• Dysphagia symptoms were common in our pediatric GER disease patients who were receiving diagnostic work up for anti-reflux surgery.• Of all parameters evaluated, bolus 'clearing pressures' were most reliably associated with dysphagia symptoms. Results: Pre-operative pressure-flow index was positively correlated with post-operative dysphagia score (viscous bolus r = 0.771, p<0.005). Of three variables that comprise the pressure-flow index, the ramp pressure measured during bolus clearance was the main driver of the effect seen (viscous bolus r = 0.819, p<0.005). Conclusions:In order to mitigate symptoms i...

show abstract

Regulation and dysregulation of esophageal peristalsis by the integrated function of circular and longitudinal muscle layers in health and disease

Cited by 46 publications

References 95 publications

Ineffective esophageal motility: Concepts, future directions, and conclusions from the Stanford 2018 symposium

Ineffective esophageal motility: Concepts, future directions, and conclusions from the Stanford 2018 symposium

Belching in Gastroesophageal Reflux Disease: Literature Review

A study of dysphagia symptoms and esophageal body function in children undergoing anti‐reflux surgery

Contact Info

Product

Resources

About