THE ESOPHAGOGASTRIC JUNCTION IN HEALTH AND DISEASE

食管胃连接处的健康与疾病

• 批准号: 6635172
• 负责人: Peter James Kahrilas
• 金额: $ 24.77万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-04-01 至 2006-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6635172
• 关键词: computer simulation; dysphagia; esophagogastric junction; gastrointestinal absorption /transport; gastrointestinal function; gastrointestinal motility /pressure; gastrointestinal pharmacology; gastrointestinal sign /symptom; gastrointestinal surgery; gastroscopy; hernia; human subject; laparoscopy; mathematical model; pathologic process; patient oriented research; physiologic stressor; postoperative complications; postoperative state; questionnaires; reflux esophagitis; rest; stimulus /response; stomach; swallowing

DESCRIPTION (Verbatim from Applicant's Abstract): Gastroesophageal reflux disease (GERD) is a common disorder, affecting millions of Americans and caused by anatomical and physiological perturbations of the esophagogastric junction (EGJ). The economic impact of GERD in the US is evident by the annual expenditure of >$4 billion for pharmaceutical treatments. Although effective, medical therapy is by nature compensatory, as opposed to potentially curative surgery. However, a problem with antireflux surgery has been unpredictable postoperative dysphagia and bloating related to a diminished ability to belch. Thus, this revised RO1 application represents a collaborative effort by a gastroenterologist (Dr Kahrilas), a surgeon (Dr Joehl), and a mechanical engineer (Dr Brasseur) to study perturbations of the EGJ imposed by GERD and by surgical treatments of GERD (Nissen fundoplication). Specific aim #1 addresses antegrade EGJ function while specific aim #2 investigates mechanisms of reflux. Antegrade EGJ function will be quantified with an "esophageal stress test" using manometry with concurrent fluoroscopy while swallowing boluses of defined viscoelastic properties. These data will be complimented by a dysphagia questionnaire. Data from controls will be compared to that of GERD patients and patients after antireflux surgery. The underlying hypothesis of specific aim #1 is that a mathematical model of the EGJ, embedded within a "computer laboratory" and based on the best anatomical and physiological data obtainable will improve understanding and prevention of post-surgical dysphagia. Specific aim #2 is focused aboutextending our investigations into the interplay between anatomical and physiological factors in the pathophysiology of GERD. Investigational methodologies include using a barostat to create measured degrees of gastric distension and to ascertain EGJ compliance during fluoroscopy of the EGJ, using intragastric air insufflation to study the physiology of transient LES relaxations and high resolution manometry to map the geometry and mobility of the EGJ. An underlying hypothesis is that the optimal surgical management of a patient with tLESR induced reflux is different than of the patient with a patulous sphincter. The ultimate goal is to tailor the surgical management of GERD for the individual patient based on physiological studies of that patient with the hope that this will improve the efficacy and reduce the complications of antireflux surgery.

描述（来自申请人摘要的逐字描述）：胃食管反流 胃食管反流病（GERD）是一种常见的疾病，影响数百万美国人， 由于食管胃连接处的解剖学和生理学扰动 （EGJ）。GERD在美国的经济影响是显而易见的， 超过40亿美元用于药物治疗。虽然有效， 药物治疗本质上是补偿性的，而不是潜在的治愈性的 手术然而，抗反流手术的问题是不可预测的 术后吞咽困难和腹胀与打嗝能力下降有关。 因此，这个修订的RO1应用程序代表了 胃肠病学家（Kahrilas博士），外科医生（Joehl博士）和机械 工程师（Brasseur博士）研究GERD和 胃食管反流病的手术治疗（尼森胃底折叠术）。具体目标#1 顺行EGJ功能，而具体目标#2研究反流机制。 将通过“食管负荷试验”量化顺行EGJ功能 在吞咽规定剂量的大剂量时，使用测压和同时进行荧光透视检查 粘弹性能这些数据将补充吞咽困难 问卷将对照组的数据与GERD患者的数据进行比较， 抗反流手术后的患者。具体目标的基本假设#1 EGJ的数学模型嵌入在“计算机”中 实验室”，并根据可获得的最佳解剖和生理数据 将提高对术后吞咽困难的理解和预防。具体 目标#2的重点是扩展我们的调查， 胃食管反流病病理生理学中的解剖和生理因素。 调查方法包括使用恒压器， 程度的胃扩张，并确定EGJ的顺应性， EGJ的荧光透视，使用胃内空气吹入来研究 瞬态LES松弛生理学和高分辨率测压以标测 EGJ的几何形状和移动性。一个潜在的假设是， tLESR诱导反流患者的最佳手术治疗是不同的 而不是括约肌扩张的病人最终目标是量身定制 个体患者的GERD手术管理基于 对该患者进行生理学研究，希望这将改善 降低抗返流手术的并发症。