Repetitive antegrade contraction: a novel response to sustained esophageal distension is modulated by cholinergic influence

2020 ◽  
Vol 319 (6) ◽  
pp. G696-G702
Author(s):  
Dustin A. Carlson ◽  
Wenjun Kou ◽  
Melina Masihi ◽  
Shashank Acharya ◽  
Alexandra J. Baumann ◽  
...  
Keyword(s):  
Esophageal Motility ◽  
Motor Response ◽  
Healthy Controls ◽  
Contraction Pattern ◽  
Imaging Probe ◽  
Asymptomatic Volunteers ◽  
Functional Luminal Imaging Probe ◽  
Esophageal Contractility

Repetitive antegrade contraction, a unique, patterned, motor response to sustained esophageal distension, is observed on functional luminal imaging probe panometry in healthy controls and patients with normal esophageal motility; however, the mechanisms related to this response are unclear. Among healthy, asymptomatic volunteers, cholinergic inhibition with atropine reduced the vigor and triggering of distension-induced esophageal contractility, although the rate at which contractions occurred in a repetitive antegrade contraction pattern was unchanged by atropine.

40 - Esophageal Motility Diagnoses can be Established at the Time of Endoscopy: A Pilot Study Evaluating Real-Time Functional Luminal Imaging Probe (Flip) Panometry

2018 ◽  
Vol 154 (6) ◽  
pp. S-13-S-14 ◽  
Author(s):  
Dustin Carlson ◽  
C. Prakash Gyawali ◽  
Peter J. Kahrilas ◽  
Joseph Triggs ◽  
Sophia Falmagne ◽  
...  
Keyword(s):  
Pilot Study ◽  
Real Time ◽  
Esophageal Motility ◽  
Imaging Probe ◽  
Functional Luminal Imaging Probe

scholarly journals Esophageal motility classification can be established at the time of endoscopy: a study evaluating real-time functional luminal imaging probe panometry

2019 ◽  
Vol 90 (6) ◽  
pp. 915-923.e1 ◽  
Author(s):  
Dustin A. Carlson ◽  
C. Prakash Gyawali ◽  
Peter J. Kahrilas ◽  
Joseph R. Triggs ◽  
Sophia Falmagne ◽  
...  
Keyword(s):  
Real Time ◽  
Esophageal Motility ◽  
Imaging Probe ◽  
Functional Luminal Imaging Probe

scholarly journals Normal Values of Esophageal Distensibility and Distension-Induced Contractility Measured by Functional Luminal Imaging Probe Panometry

2019 ◽  
Vol 17 (4) ◽  
pp. 674-681.e1 ◽  
Author(s):  
Dustin A. Carlson ◽  
Wenjun Kou ◽  
Zhiyue Lin ◽  
Monique Hinchcliff ◽  
Anjali Thakrar ◽  
...  
Keyword(s):  
Normal Values ◽  
Imaging Probe ◽  
Functional Luminal Imaging Probe

scholarly journals Mechanisms of repetitive retrograde contractions in response to sustained esophageal distension: a study evaluating patients with postfundoplication dysphagia

2018 ◽  
Vol 314 (3) ◽  
pp. G334-G340 ◽  
Author(s):  
Dustin A. Carlson ◽  
Peter J. Kahrilas ◽  
Katherine Ritter ◽  
Zhiyue Lin ◽  
John E. Pandolfino
Keyword(s):  
Nissen Fundoplication ◽  
Motor Disorder ◽  
Outflow Obstruction ◽  
Imaging Probe ◽  
High Resolution Manometry ◽  
Type Iii ◽  
Common Response ◽  
Barium Esophagram ◽  
Functional Luminal Imaging Probe ◽  
Type Iii Achalasia

Repetitive retrograde contractions (RRCs) in response to sustained esophageal distension are a distinct contractility pattern observed with functional luminal imaging probe (FLIP) panometry that are common in type III (spastic) achalasia. RRCs are hypothesized to be indicative of either impaired inhibitory innervation or esophageal outflow obstruction. We aimed to apply FLIP panometry to patients with postfundoplication dysphagia (a model of esophageal obstruction) to explore mechanisms behind RRCs. Adult patients with dysphagia after Nissen fundoplication ( n = 32) or type III achalasia ( n = 25) were evaluated with high-resolution manometry (HRM) and upper endoscopy with FLIP. HRM studies were assessed for outflow obstruction and spastic features: premature contractility, hypercontractility, and impaired deglutitive inhibition during multiple-rapid swallows. FLIP studies were analyzed to determine the esophagogastric junction (EGJ)-distensibility index and contractility pattern, including RRCs. Barium esophagram was evaluated when available. RRCs were present in 8/32 (25%) fundoplication and 19/25 (76%) achalasia patients ( P < 0.001). EGJ outflow obstruction was detected in 21 (67%) fundoplication patients by HRM, FLIP, or esophagram [6 (29%) had RRCs]. On HRM, none of the fundoplication patients had premature contractility, whereas 3/4 with defective inhibition on multiple-rapid swallows and 2/4 with hypercontractility had RRCs. Regression analysis demonstrated HRM with spastic features, but not esophageal outflow obstruction, as a predictor for RRCs. RRCs in response to sustained esophageal distension appear to be a manifestation of spastic esophageal motility. Although future study to further clarify the significance of RRCs is needed, RRCs on FLIP panometry should prompt evaluation for a major motor disorder. NEW & NOTEWORTHY Repetitive retrograde contractions (RRCs) are a common response to sustained esophageal distension among spastic achalasia patients when evaluated with the functional luminal imaging probe. We evaluated patients with postfundoplication dysphagia, i.e., patients with suspected mechanical obstruction, and found that RRCs occasionally occurred among postfundoplication patients, but often in association with manometric features of esophageal neuromuscular imbalance. Thus, RRCs appear to be a manifestation of spastic esophageal dysmotility, likely from neural imbalance resulting in excess excitation.

scholarly journals Functional Luminal Imaging Probe Panometry Identifies Achalasia-Type Esophagogastric Junction Outflow Obstruction

2020 ◽  
Vol 18 (10) ◽  
pp. 2209-2217 ◽  
Author(s):  
Joseph R. Triggs ◽  
Dustin A. Carlson ◽  
Claire Beveridge ◽  
Wenjun Kou ◽  
Peter J. Kahrilas ◽  
...  
Keyword(s):  
Esophagogastric Junction ◽  
Outflow Obstruction ◽  
Imaging Probe ◽  
Functional Luminal Imaging Probe
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