A mechanics-based perspective on the function of the esophagogastric junction during functional luminal imaging probe manometry.
A mechanics-based perspective on the function of the esophagogastric junction during functional luminal imaging probe manometry.
复制标题
功能性管腔成像探针测压期间食管胃连接处功能的基于力学的视角。
DOI：
10.1007/s10237-023-01688-4
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发表时间：
2023
影响因子：
3.5
通讯作者：
Patankar,NeeleshA
中科院分区：
文献类型：
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作者：
Elisha,Guy;Halder,Sourav;Acharya,Shashank;Carlson,DustinA;Kou,Wenjun;Kahrilas,PeterJ;Pandolfino,JohnE;Patankar,NeeleshA
食管胃交界（EGJ）位于食管的远端，作为一个阀门，允许吞咽的食物进入胃，防止胃酸反流。不规则的减弱或僵硬的EGJ肌肉导致其打开和关闭模式的变化，可进展为食道疾病。因此，了解EGJ打开和关闭循环的物理原理可以提供对其功能的机制见解，并有助于确定导致其功能障碍的潜在条件。利用临床功能性管腔成像探头（FLIP）数据，我们绘制了EGJ位置的压力横截面积环路，并区分了两种主要环路类型——压力主导环路和音调主导环路。在本研究中，我们旨在确定定义每种循环类型的关键特征，并确定导致从一个循环到另一个循环反转的原因。为此，使用位于食道的FLIP装置内流动的一维模拟再现临床观察结果，并计算EGJ壁随时间的功。这项工作被分解为主动和被动组件，揭示了决定循环类型的竞争机制。这些机制是食道僵硬、液体粘度和EGJ松弛模式。
The esophagogastric junction (EGJ) is located at the distal end of the esophagus and acts as a valve allowing swallowed food to enter the stomach and preventing acid reflux. Irregular weakening or stiffening of the EGJ muscles results in changes to its opening and closing patterns which can progress into esophageal disorders. Therefore, understanding the physics of the opening and closing cycle of the EGJ can provide mechanistic insights into its function and can help identify the underlying conditions that cause its dysfunction. Using clinical functional lumen imaging probe (FLIP) data, we plotted the pressure-cross-sectional area loops at the EGJ location and distinguished two major loop types—a pressure dominant loop and a tone dominant loop. In this study, we aimed to identify the key characteristics that define each loop type and determine what causes the inversion from one loop to another. To do so, the clinical observations are reproduced using 1D simulations of flow inside a FLIP device located in the esophagus, and the work done by the EGJ wall over time is calculated. This work is decomposed into active and passive components, which reveal the competing mechanisms that dictate the loop type. These mechanisms are esophageal stiffness, fluid viscosity, and the EGJ relaxation pattern.