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Novel Electrical Impedance Methodology to Understand Functional Dysphagia

了解功能性吞咽困难的新型电阻抗方法

基本信息

批准号：
10888503
负责人：
RAVINDER K. MITTAL
金额：
$ 68.22万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-15 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10888503
关键词：
Affect American Animals Area Barium swallow Biological Products Bolus Infusion Cells Cephalic Chicago Classification Deglutition Deglutition Disorders Diagnosis Distal Electrophysiology (science)Endoscopy Eosinophilic Esophagitis Esophageal Diseases Esophageal motility disorders Esophagogastric Junction Esophagus Functional disorder Funding Fundoplication Future Gastrointestinal tract structure General Population Goals Image Analysis Impairment In Vitro Infusion procedures Intestines Label Laws Length Location Manometry Manufactured football Measurement Measures Methodology Methods Modality Movement Muscle Muscle function Obstruction Operative Surgical Procedures Patients Peristalsis Pharmacology Phase Reflex action Reflux Relaxation Resistance Resolution Shapes Sturnus vulgaris Symptoms Techniques Testing Therapeutic Time Travel Ultrasonography clinical practice critical period diagnostic strategy driving force electric impedance imaging probe in vivo motor disorder novel pharmacologic pressure side effect spasticity treatment response treatment strategy

项目摘要

Summary/Abstract Dysphagia or difficulty swallowing affects 15-20% of the general population in the USA. The reason for dysphagia remains unclear in large number of patients even after extensive testing using multiple modalities such as endoscopy, barium swallow and esophageal manometry. The current method of measuring esophageal peristalsis, i.e., high resolution manometry (HRM) measures only the contraction phase of peristalsis; Chicago classification of esophageal motility disorders is based on the abnormalities in the contraction phase of peristalsis. Measuring esophageal inhibition during peristalsis has been a challenge. From a functional point of view, the purpose of the inhibition phase is the relaxation of circular and longitudinal muscle so that bolus can flow through the relaxed segment with minimal resistance. The last funding period allowed us to develop methodologies to measure the luminal CSA/esophageal distension (marker of inhibition) from the intraluminal impedance measurements; advantage of which is that one can measure luminal CSA/distension at closely spaced intervals along the entire length of the esophagus, relatively easily. Using above methodology, we found abnormalities in the distension phase of esophageal peristalsis in number of patient groups with dysphagia who have normal contraction phase of peristalsis. These patients are currently labelled as functional dysphagia and there are no proper strategies to diagnose and treat this large group of patients. The goals of our future studies are to determine, 1) the mechanism of poor distension of the esophagus in patients with functional dysphagia, 2) whether pharmacologic agents that influence the contraction phase of peristalsis have an effect on the distension phase of peristalsis in normal subjects and patients with functional dysphagia, 3) whether poor distensibility and longitudinal muscle dysfunction seen in patients with eosinophilic esophagitis is reversible following treatment with a newly approved biologic agent for its treatment, 4) whether Nissen fundoplication surgery leads to poor distensibility of the esophagus, and if one can predict which patient may develop dysphagia following surgery. Overall, we believe that continued studies in the above direction will lead to better diagnostic and treatment strategies for dysphagia symptom.

总结/摘要吞咽困难或吞咽困难影响美国15 - 20%的一般人群。的原因即使在使用多种方式进行广泛测试后，大量患者的吞咽困难仍不清楚例如内窥镜检查、吞钡和食管测压。目前的测量方法食管炎，即，高分辨率测压（HRM）仅测量收缩期，食管动力障碍的芝加哥分类是基于收缩期。测量食管炎期间的食管抑制一直是一个挑战。从从功能上看，抑制相的目的是放松圆周和纵向肌肉，使弹丸可以通过松弛段流动，阻力最小。最后一个供资期使我们能够开发测量管腔CSA/食管扩张（抑制标志物）的方法从管腔内阻抗测量;其优点是可以测量管腔内阻抗。 CSA/扩张在沿着食管的整个长度以紧密间隔，相对容易。使用上述方法，我们发现异常的扩张阶段的食管扩张的数量，吞咽困难的患者组，具有正常的吞咽收缩期。这些患者目前标签为功能性吞咽困难，没有适当的策略来诊断和治疗这一大群患者我们未来研究的目标是确定，1）扩张不良的机制，功能性吞咽困难患者的食管，2）是否有药物影响在正常受试者中，痉挛的收缩期对痉挛的扩张期有影响，功能性吞咽困难患者，3）是否存在扩张性差和纵向肌肉功能障碍，嗜酸性食管炎患者在接受新批准的生物制剂治疗后是可逆的，其治疗，4）Nissen胃底折叠术是否会导致食管扩张性差，以及如果可以预测哪位患者在手术后可能会出现吞咽困难。总的来说，我们认为持续的研究在上述方向将导致更好的诊断和治疗吞咽困难症状的策略。