Novel Electrical Impedance Methodology to Understand Functional Dysphagia

摘要/摘要 吞咽困难或吞咽困难影响了美国15%-20%的总人口。其原因是 即使在使用多种方式进行了广泛的测试后，大量患者的吞咽困难仍不清楚 如内窥镜、吞钡和食道测压。目前的测量方法 食道蠕动，即高分辨率测压(HRM)仅测量食道收缩相 蠕动；芝加哥对食道动力障碍的分类是基于 蠕动的收缩阶段。测量蠕动过程中的食道抑制一直是一个挑战。从… 从功能上看，抑制阶段的目的是松弛圆形和纵向 这样，推进剂就能以最小的阻力流过松弛的部分。最后一个资助期 使我们能够开发方法来测量管腔CsA/食道扩张(抑制的标志) 从管腔内阻抗测量；其优点是可以测量管腔 CSA/扩张在沿整个食道长度的紧密间隔内进行，相对容易。vbl.使用 以上方法，我们发现在扩张期的食道蠕动异常的数量 吞咽困难患者组具有正常的蠕动收缩时相。这些患者目前 被标记为功能性吞咽困难，并且没有适当的策略来诊断和治疗这一大群 病人。我们未来研究的目标是确定：1)关节扩张不良的机制 食道功能性吞咽困难患者，2)是否有影响食道功能的药理因素 正常受试者蠕动收缩时相对蠕动扩张时相有影响 功能性吞咽困难患者，3)扩张性差和纵向肌肉功能障碍是否见于 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 它的治疗，4)尼森胃底折叠术是否导致食道扩张性差，如果 可以预测哪位患者会在手术后出现吞咽困难。总体而言，我们认为继续研究 以上方向将导致对吞咽困难症状的更好的诊断和治疗策略。

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.