Estimation of mechanical work done to open the esophagogastric junction using functional lumen imaging probe panometry
Estimation of mechanical work done to open the esophagogastric junction using functional lumen imaging probe panometry
复制标题
DOI：
10.1152/ajpgi.00032.2021
复制
发表时间：
2021-05-01
影响因子：
4.5
通讯作者：
Patankar, Neelesh A.
中科院分区：
文献类型：
--
作者：
Acharya, Shashank;Halder, Sourav;Patankar, Neelesh A.
在这项研究中，我们量化了食道打开食管胃交界处（EGJ）并为药物流入胃创造通道所做的工作。在EGJ上所做的工作使用功能性管腔成像探针（FLIP）全景测量法计算。85名患者在镇静内镜检查期间使用16厘米导管进行FLIP全测量，包括无症状对照组（n = 14）， 45名贲门失弛缓症患者（各n = 15，三种亚型），胃食管反流病患者（GERD, n = 13），嗜酸性食管炎患者（EoE, n = 8）和系统性硬化症患者（SSc, n = 5）。通过放置在EGJ上的FLIP导管测量腔内横截面积（CSA）和压力。在40-mL膨胀时计算EGJ （EGJW）的功（毫焦耳，mJ）。此外，研究人员还开发了一种单独的方法来估计在作业过程中EGJ未打开时完全打开EGJROW所需的“工作量”。对照组EGJW的中位数[四分位数间距（IQR）]为75 (56-141)mJ。与对照组相比，所有失弛缓症亚型EGJW均较低（P < 0.001）。GERD和EoE组EGJW分别为54.1（6.9-96.3）和65.9 (10.8-102.3)mJ，与对照组相似（P < 0.08和P < 0.4）。硬皮病组EGJW较低，为12 mJ （P < 0.001）。对于贲门失弛缓症患者，EGJROW值最大，为210.4 (115.2-375.4)mJ。EGJ开口极少或缺失的疾病组EGJW值较低。对于贲门失弛缓症患者，EGJROW显著高于其他各组EGJW值，凸显其独特的病理生理。平衡EGJW和EGJROW之间的关系可能有助于校准失弛缓症治疗和评估治疗反应。新的和值得注意的变化，压力和直径发生在食管排空期间EGJ。在FLIP全景测量中可以观察到类似的变化。来自健康和患病个体的数据被用来估计在膨胀引起的松弛期间对EGJ所做的机械功，或者在打开失败的情况下，打开EGJ所需的功。量化这些参数对EGJ功能障碍，特别是失弛缓症患者的治疗方法和治疗效果的评估具有潜在的价值。
In this study, we quantify the work done by the esophagus to open the esophagogastric junction (EGJ) and create a passage for bolus flow into the stomach. Work done on the EGJ was computed using functional lumen imaging probe (FLIP) panometry. Eighty-five individuals underwent FLIP panometry with a 16-cm catheter during sedated endoscopy including asymptomatic controls (n = 14), 45 patients with achalasia (n = 15 each, three subtypes), those with gastroesophageal reflux disease (GERD; n = 13), those with eosinophilic esophagitis (EoE; n = 8), and those with systemic sclerosis (SSc; n = 5). Luminal cross-sectional area (CSA) and pressure were measured by the FLIP catheter positioned across the EGJ. Work done on the EGJ (EGJW) was computed (millijoules, mJ) at 40-mL distension. Additionally, a separate method was developed to estimate the "work required" to fully open the EGJ (EGJROW) when it did not open during the procedure. EGJW for controls had a median [interquartile range (IQR)] value of 75 (56-141) mJ. All achalasia subtypes showed low EGJW compared with controls (P < 0.001). Subjects with GERD and EoE had EGJW 54.1 (6.9-96.3) and 65.9 (10.8-102.3) mJ, similar to controls (P < 0.08 and P < 0.4, respectively). The scleroderma group showed low values of EGJW, 12 mJ (P < 0.001). For patients with achalasia, EGJROW was the greatest and had a value of 210.4 (115.2-375.4) mJ. Disease groups with minimal or absent EGJ opening showed low values of EGJW. For patients with achalasia, EGJROW significantly exceeded EGJW values of all other groups, highlighting its unique pathophysiology. Balancing the relationship between EGJW and EGJROW is potentially useful for calibrating achalasia treatments and evaluating treatment response.NEW & NOTEWORTHY Changes in pressure and diameter occur at the EGJ during esophageal emptying. Similar changes can be observed during FLIP panometry. Data from healthy and diseased individuals were used to estimate the mechanical work done on the EGJ during distension-induced relaxation or, in instances of failed opening, work required to open the EGJ. Quantifying these parameters is potentially valuable to calibrate treatments and gauge treatment efficacy for subjects with disorders of EGJ function, especially achalasia.