Dissecting oesophageal sensori-motor functions: the fourth domain.
Dissecting oesophageal sensori-motor functions: the fourth domain.
复制标题
剖析食管感觉运动功能：第四领域。
DOI：
10.1111/j.1365-2982.2006.00766.x
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发表时间：
2006
期刊：
影响因子：
--
通讯作者：
Bharucha,AdilE
中科院分区：
文献类型：
--
作者：
Bharucha,AdilE
Perhaps because the oesophagus is relatively accessible and often a source of unexplained discomfort, several new techniques to assess gastrointestinal sensorimotor functions have been initially tested in the oesophagus. Continuing that tradition, this issue of the Journal contains a description of a sophisticated device that incorporates manometric sensors, an ultrasound probe, and a laser Doppler probe for use within the oesophagus. 1 Conceptually, it is useful to consider the four physiological domains which can be assessed in the oesophagus by the available techniques. The first domain pertains to propagation of contractions (ie peristalsis) and bolus transit, made possible by manometry, as in this device, and intraluminal impedance testing respectively. The second domain is perception, which can be measured by distending an oesophageal balloon with a barostat or by impedance planimetry. A barostat can simultaneously measure pressure–volume relationships, while impedance planimetry can also measure luminal cross-sectional area. The third domain is wall thickness, which can be measured by intra-luminal ultrasound but not by impedance planimetry. Measurements of wall thickness are necessary to calculate stress (stress≅ tension/wall thickness) and are particularly useful for the oesophagus, because it is not a thin viscus. In addition, ultrasound can also separately assess muscle shortening in the longitudinal and circular layers. 2 This device also measures a fourth domain, ie visceral blood flow, by laser Doppler flowmetry. Measurements of visceral blood flow have not previously been combined with assessments of gastrointestinal sensori-motor functions.Manometry is extremely useful for identifying peristaltic dysfunction. 3 In the oesophagus, the concurrent assessment of two or more domains has substantially enhanced our understanding of normal and disordered functions. Perhaps the most striking example is concurrent videofluoroscopy and manometry, which has provided substantial insights into normal and disordered functions in the oropharynx, oesophageal body and lower oesophageal sphincter. 3, 4 Oesophageal flow can also be related to manometric pressure profiles by combined impedance manometry, which revealed functional differences between the proximal and distal oesophagus. 5 The addition of impedance to ambulatory pH studies has fostered increased awareness of nonacid reflux. 6 By providing a combined assessment of oesophageal biomechanics and sensation, impedance planimetry and intraluminal ultrasound have revealed features suggestive of a disordered oesophageal contractility in non-cardiac chest pain and motor disorders such as nutcracker oesophagus. Thus, Rao et al. used impedance planimetry to demonstrate that during oesophageal distention, the oesophagus was hyperreactive, stiffer (ie less compliant) and hypersensitive in patients with atypical chest pain. 7 Intraluminal ultrasound has the unique ability to measure thickness of the entire wall, longitudinal and circular smooth muscle thickness and contraction. 2 Circular muscle contraction is manifest as changes in luminal calibre, which can be measured directly by impedance planimetry or ultrasound, or indirectly by manometry. Assuming that tissue mass and volume remain con-
