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

Prediction of Esophageal Retention: A Study Comparing High-Resolution Manometry and Functional Luminal Imaging Probe Panometry

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Dustin A. Carlson ◽  
Alexandra J. Baumann ◽  
Jacqueline E. Prescott ◽  
Jacob M. Schauer ◽  
Amanda Krause ◽  
...  
Keyword(s):  
High Resolution ◽  
Imaging Probe ◽  
High Resolution Manometry ◽  
Functional Luminal Imaging Probe

scholarly journals Focal Achalasia – Case Report and Review of the Literature

2018 ◽  
Vol 91 (1) ◽  
pp. 120-128
Author(s):  
Marcus Joachim Herzig ◽  
Radu Tutuian
Keyword(s):  
Lower Esophageal Sphincter ◽  
Botulinum Toxin Injection ◽  
Esophageal Achalasia ◽  
Distal Esophagus ◽  
High Resolution Manometry ◽  
Hypertensive Lower Esophageal Sphincter ◽  
The Neural Network ◽  
Barium Esophagram ◽  
Esophageal Sphincter ◽  
Type Iii Achalasia

Esophageal achalasia is a primary smooth muscle motility disorder specified by aperistalsis of the tubular esophagus in combination with a poorly relaxing and occasionally hypertensive lower esophageal sphincter (LES). These changes occur secondary to the destruction of the neural network coordinating esophageal peristalsis and LES relaxation (plexus myentericus). There are limited data on segmental involvement of the esophagus in adults.We report on the case of a 54-year-old man who presented initially with complete aperistalsis limited to the distal esophagus. After a primary good response to BoTox-infiltration of the distal esophagus the patient relapsed two years later. The manometric recordings documented now a progression of the disease with a poorly relaxing hypertensive lower esophageal sphincter and complete aperistalsis of the tubular esophagus (type III achalasia according to the Chicago 3.0 classification system).This paper also reviews diagnostic findings (including high resolution manometry, CT scan, barium esophagram, upper endoscopy and upper endoscopic ultrasound data) in patients with achalasia and summarizes the therapeutic options (including pneumatic balloon dilatation, botulinum toxin injection, surgical or endoscopic myotomy).

Functional Luminal Imaging Probe (FLIP) as an Adjunctive Modality in Evaluation of Esophageal Dysmotility

2021 ◽  
Vol 1 (3) ◽  
pp. 286-295
Author(s):  
Domenico A. Farina ◽  
Dustin A. Carlson
Keyword(s):  
High Resolution ◽  
Clinical Settings ◽  
Esophageal Dysmotility ◽  
Therapy Outcomes ◽  
Esophageal Diseases ◽  
Imaging Probe ◽  
High Resolution Manometry ◽  
Functional Luminal Imaging Probe ◽  
Secondary Peristalsis ◽  
Post Therapy

The Functional Luminal Imaging Probe (FLIP) has emerged as a valuable adjunctive tool in the evaluation of esophageal diseases. Using volumetric distension, FLIP can assess secondary peristalsis and detect esophageal abnormalities that may not be evaluated by high-resolution manometry (HRM). In certain clinical settings, FLIP may allow for deferral of HRM. In therapy for esophageal diseases, FLIP has demonstrated value for its real-time interpretation, which can be used intra-procedurally to tailor therapy and to predict post-therapy outcomes. The future of FLIP looks promising as surgeons and gastroenterologists place increasing emphasis on non-manometric data to diagnose esophageal motility disorders.

scholarly journals Elevated Average Maximum Intrabolus Pressure on High-Resolution Manometry is Associated with Esophageal Dysmotility and Delayed Esophageal Emptying on Timed Barium Esophagram

2021 ◽  
Author(s):  
Katelyn Madigan ◽  
J. Shawn Smith ◽  
Joni Evans ◽  
Steven Clayton
Keyword(s):  
High Resolution ◽  
Esophagogastric Junction ◽  
Esophageal Dysmotility ◽  
Outflow Obstruction ◽  
High Resolution Manometry ◽  
Chicago Classification ◽  
Average Maximum ◽  
Barium Esophagram ◽  
Esophageal Emptying ◽  
Liquid Bolus

Abstract Background Intrabolus pressure (IBP) recorded by high-resolution manometry (HRM) portrays the compartmentalized force on a bolus during esophageal peristalsis. HRM may be a reliable screening tool for esophageal dysmotility in patients with elevated average maximum IBP (AM-IBP). Timed barium esophagram (TBE) is a validated measure of esophageal emptying disorders, such as esophagogastric junction outflow obstruction and achalasia. This study aimed to determine if an elevated AM-IBP correlates with esophageal dysmotility on HRM and/or delayed esophageal emptying on TBE. Methods A retrospective analysis of all HRM (unweighted sample n=155) performed at a tertiary referral center from 09/2015-03/2017 yielded a case group (n=114) with abnormal AM-IBP and a control group (n=41) with a normal AM-IBP (pressure<17mmHg) as consistent with Chicago Classification 3. All patients received a standardized TBE, with abnormalities classified as greater than 1 cm of retained residual liquid barium in the esophagus at 1 and 5 minutes or as tablet retention after 5 minutes. Results AM-IBP was significantly related to liquid barium retention (p=0.003) and tablet arrest on timed barium esophagram (p=0.011). A logistic regression model correctly predicted tablet arrest in 63% of cases. Tablet arrest on AM-IBP correlated with an optimal prediction point at 20.1 mmHg on HRM. Patients with elevated AM-IBP were more likely to have underlying esophageal dysmotility (95.6% vs. 70.7% respectively; p<0.001), particularly esophagogastric junction outflow obstruction disorders. Elevated AM-IBP was associated with incomplete liquid bolus transit on impedance analysis (p=0.002). Conclusions Our findings demonstrate that an elevated AM-IBP is associated with abnormal TBE findings of esophageal tablet retention and/or bolus stasis. An abnormal AM-IBP (greater than 20.1 mm Hg) was associated with a higher probability of retaining liquid bolus or barium tablet arrest on TBE and esophageal dysmotility on HRM. This finding supports the recent incorporation of IBP in Chicago Classification v4.0.

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