Dataset Information

The rhythm and rate of distension-induced esophageal contractility: A physiomarker of esophageal function.

ABSTRACT:

Background

Distention of the esophagus elicits a unique pattern of repetitive contractions in healthy controls. We aimed to assess the rhythm and rate of distension-induced contractile patterns between achalasia and controls and identify factors that distinguish the normal contractile response to distension.

Methods

Twenty asymptomatic controls and 140 adult patients with treatment-naïve achalasia defined by HRM (29 type I, 81 type II, 30 type III) were prospectively evaluated with functional luminal imaging probe (FLIP) during sedated endoscopy. 16-cm FLIP balloons were positioned within the distal esophagus during stepwise balloon distension. Functional luminal imaging probe panometry studies were retrospectively analyzed using a customized program.

Key results

All controls had contractility in a repetitive antegrade contraction (RAC) pattern with a rate of mean (10-90th) 6 (4-8) contractions per minute. 19/20 controls had > 6 consecutive antegrade contractions (ACs), that is, duration > 6 ACs, >6 cm in length, at a rate of 6 ± 3 contractions per minute (met the "Rule-of-6s"). 50 achalasia patients had repetitive contractions that occurred at a rates of 11 (7 - 15) ACs per minute; P < .001 compared with controls, or 12 (8-15) repetitive retrograde contractions per minute. Only 1/140 achalasia patients had a contractile response that met the "Rule-of-6s."

Conclusion

The normal contractile response to sustained distention is associated with > 6 RACs with a consistent rate of 6 ± 3 per minute, which was exceptionally rare in achalasia. These findings support that the RAC pattern is disrupted in achalasia and the faster rate may be a manifestation of abnormal inhibition and/or a reduced refractory period.

SUBMITTER: Carlson DA

PROVIDER: S-EPMC7182495 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND & AIMS:Functional luminal imaging probe (FLIP) panometry provides a comprehensive evaluation of esophageal functional at the time of endoscopy, including assessment of esophageal distensibility and distension-induced esophageal contractility. However, the few and inconsistent findings from healthy individuals pose challenges to the application of FLIP to research and clinical practice. We performed FLIP panometry in asymptomatic volunteers. METHODS:We performed a prospective study of 20 asymptomatic volunteers (ages, 23-44; 14 women) who were evaluated with 16-cm FLIP positioned across the esophagogastric junction (EGJ) and distal esophagus (and in 8 subjects also repositioned at the proximal esophagus) during sedated upper endoscopy. FLIP data were analyzed with a customized program that generated FLIP panometry plots and calculated the EGJ-distensibility index (DI) and distensibility plateaus (DP) of distal and proximal esophageal body. Distension-induced esophageal contractility was also assessed. RESULTS:The median EGJ-DI was 5.8 mm2/mm Hg (interquartile range [IQR], 4.9-6.7 mm2/mm Hg); all 20 subjects had an EGJ-DI greater than 2.8 mm2/mm Hg. The median DP values from all subjects tested were 20.2 mm (IQR, 19.8-20.8 mm) at the distal body, 21.1 mm (IQR, 20.3-22.9 mm) at the proximal body, and greater than 18 mm at both locations. Repetitive antegrade contractions (RACs) were observed in all 20 subjects; in 19 of 20 (95%) subjects, the RAC pattern persisted for 10 or more consecutive antegrade contractions. CONCLUSIONS:Normal parameters of FLIP panometry are EGJ-DI greater than 2.8 mm2/mm Hg, DP greater than 18 mm, and antegrade contractions that occur in a repetitive pattern (RACs)-these can be used as normal findings for esophageal distensibility and distension-induced contractility. These values can be used in comparative studies of esophageal diseases, such as achalasia and eosinophilic esophagitis, and will facilitate application of FLIP panometry to clinical practice.

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