The mechanics of symptom generation in dysphagia

项目摘要 吞咽困难是非常常见的，并导致生活质量的大幅下降 不管是什么原因的病人。不幸的是，我们对病理生理学的理解 对症状产生的解释很差。在思考食道症状的发生时 将注意力集中在团注内压(IBP)上是合乎逻辑的，因为这是排空的主要力量。 食道。团注内压力取决于许多因素；然而，主要决定因素是 从食道流出时的EGJ顺应性高度依赖于EGJ直径。对此的假设是 提案的重点是IBP和EGJ依从性之间的关系，因为它与吞咽困难的症状有关 还有胸痛。因此，本提案的目标是：1)定义IBP和IBP之间的生理关系 EGJ依从性，2)确定症状严重程度与IBP异常之间的相关性，以及3)研究 食道敏感性与IBP在症状发生中的关系 为了实现上述目标，一套全面的解剖学和生理学研究 重点测量团注内压、蠕动完整性、食管壁厚度和顺应性 EGJ阐明EGJ顺应性和团注内压在产生食道症状中的作用 在吞咽过程中将被执行。将使用阻抗平面法确定EGJ合规性 创建EGJ几何体的多维渲染，同时团注内压力和蠕动完整性 使用固态人力资源管理系统进行评估。阻抗平面仪也将用于评估食道 敏感度、生活质量和心理社会问卷也将纳入分析，如下所示 这些都是症状感知中的重要变量。 我们已经验证了几种新的技术来测量团注的力学相关变量 中转。这些生理和力学变量将被用来评估症状之间的相关性 严重程度和食道排空的机制。此外，还将开发统计模型以帮助 预测EGJ依从性对IBP的影响。这些机械变量的临床相关性将是 在评估侧重于提高EGJ依从性和降低IBP的治疗效果的研究中得到验证 在症状感知上。患者将在治疗前后进行食道敏感性分析，以控制 分析中的这个变量。我们这项建议的最终目标是开发和验证新的分析 将关注食道感觉和静脉推注之间的力学关系的范例 压力。这些新的分析技术将改进相关食道运动的诊断分类 还有助于确定哪些患者可能受益于以减少静脉注射为重点的治疗 压力。

Project Summary Swallowing difficulties are extremely common and result in a substantial reduction in the quality of life for patients regardless of the cause. Unfortunately, our understanding regarding the pathophysiologic explanation for symptom generation is poor. In contemplating the occurrence of esophageal symptoms during swallowing it is logical to focus attention on intrabolus pressure (IBP), as this is the primary force that empties the esophagus. Intrabolus pressure is dependent on a number of factors; however, the primary determinant is EGJ compliance as flow out of the esophagus is highly dependent on EGJ diameter. The hypothesis for this proposal focuses on the relationship between IBP and EGJ compliance as it relates to symptoms of dysphagia and chest pain. Thus, the goals of this proposal are:1) to define the physiologic relationship between IBP and EGJ compliance, 2) determine the correlation between symptom severity and IBP abnormalities, and 3) study the relationship between esophageal sensitivity and IBP in symptom generation. In order to accomplish the above goals, a comprehensive set of anatomical and physiological studies focused on measuring intrabolus pressure, peristaltic integrity, esophageal wall thickness and compliance of the EGJ to elucidate the role of EGJ compliance and intrabolus pressure in generating esophageal symptoms during swallowing will be performed. EGJ compliance will be determined using impedance planimetry to create a multidimensional rendering of EGJ geometry, while intrabolus pressure and peristaltic integrity will be assessed using a solid-state HRM system. Impedance planimetry will also be used to assess esophageal sensitivity and quality of life and psychosocial questionnaires will also be incorporated into the analysis as these are important variables in symptom perception. We have validated several new techniques to measure the mechanically relevant variables of bolus transit. These physiologic and mechanical variables will be used to assess the correlation between symptom severity and the mechanics of esophageal emptying. In addition, statistical models will be developed to help predict the effect EGJ compliance has on IBP. The clinical relevance of these mechanical variables will be validated in a study assessing the effect of therapy focused on increasing EGJ compliance and reducing IBP on symptom perception. Patients will have esophageal sensitivity analysis before and after therapy to control this variable in the analysis. Our ultimate goal for this proposal is to develop and validate novel analysis paradigms that will focus on the mechanical relationship between esophageal sensation and intrabolus pressure. These new analysis techniques will improve diagnostic classification of relevant esophageal motor disease and also help determine which patients may benefit from treatment focused on reducing intrabolus pressure.