THE ESOPHAGOGASTRIC JUNCTION IN HEALTH AND DISEASE

食管胃连接处的健康与疾病

• 批准号: 6727713
• 负责人: Peter James Kahrilas
• 金额: $ 24.68万
• 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/6727713
• 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（逐字摘自申请人摘要）：胃食管反流 疾病（GERD）是一种常见疾病，影响数百万美国人并导致 通过食管胃交界处的解剖学和生理学扰动 （EGJ）。 GERD 对美国经济的影响从每年的 用于药物治疗的支出超过 40 亿美元。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治疗 外科手术。然而，抗反流手术的一个问题是不可预测的 术后吞咽困难和腹胀与打嗝能力减弱有关。 因此，修订后的 RO1 申请代表了以下各方的共同努力： 胃肠病学家（Kahrilas 博士）、外科医生（Joehl 博士）和机械师 工程师（Brasseur 博士）研究 GERD 和 GERD 的手术治疗（尼森胃底折叠术）。具体目标#1地址 顺行 EGJ 功能，而具体目标#2 研究反流机制。 顺行 EGJ 功能将通过“食管压力测试”进行量化 使用测压法并同时进行透视检查，同时吞咽规定剂量的丸剂 粘弹性特性。这些数据将得到吞咽困难的补充 调查问卷。对照组的数据将与 GERD 患者的数据进行比较 抗反流手术后的患者。具体目标 #1 的基本假设 是嵌入在“计算机”中的 EGJ 数学模型 实验室”并基于可获得的最佳解剖学和生理学数据 将提高对术后吞咽困难的认识和预防。具体的 目标 #2 的重点是扩大我们对两者之间相互作用的调查 GERD 病理生理学中的解剖学和生理学因素。 研究方法包括使用恒压器来创建测量值 胃扩张程度并确定 EGJ 顺应性 EGJ 透视，使用胃内吹气来研究 瞬时 LES 松弛的生理学和高分辨率测压图 EGJ 的几何形状和移动性。一个基本假设是 tLESR 引起的反流患者的最佳手术治疗是不同的 与括约肌扩张的患者相比。最终目标是量身定制 针对个体患者的 GERD 手术治疗基于 对该患者进行生理学研究，希望这能改善 疗效并减少抗反流手术的并发症。