Assessment of esophageal body peristaltic work using functional lumen imaging probe panometry

Shashank Acharya, Sourav Halder, Dustin A. Carlson, Wenjun Kou, Peter J. Kahrilas, John E. Pandolfino, Neelesh A. Patankar*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

The goal of this study was to conceptualize and compute measures of "mechanical work"done by the esophagus using data generated during functional lumen imaging probe (FLIP) panometry and compare work done during secondary peristalsis among patients and controls. Eighty-five individuals were evaluated with a 16-cm FLIP during sedated endoscopy, including asymptomatic controls (n = 14) and those with achalasia subtypes I, II, and III (n = 15, each); gastroesophageal reflux disease (GERD; n = 13); eosinophilic esophagitis (EoE; n = 9); and systemic sclerosis (SSc; n = 5). The FLIP catheter was positioned to have its distal segment straddling the esophagogastric junction (EGJ) during stepwise distension. Two metrics of work were assessed: "active work"(during bag volumes≤40mL where contractility generates substantial changes in lumen area) and "work capacity"(for bag volumes≥60mL when contractility cannot substantially alter the lumen area). Controls showed median [interquartile range (IQR)] of 7.3 (3.6-9.2) mJ of active work and 268.6 (225.2-332.3) mJ of work capacity. Patients with all achalasia subtypes, GERD, and SSc showed lower active work done than controls (P ≤0.003). Patients with achalasia subtypes I and II, GERD, and SSc had lower work capacity compared with controls (P < 0.001, 0.004, 0.04, and 0.001, respectively). Work capacity was similar between controls and patients with achalasia type III and EoE. Mechanical work of the esophagus differs between healthy controls and patient groups with achalasia, EoE, SSc, and GERD. Further studies are needed to fully explore the utility of this approach, but these work metrics would be valuable for device design (artificial esophagus), to measure the efficacy of peristalsis, to gauge the physiological state of the esophagus, and to comment on its pumping effectiveness.

Original languageEnglish (US)
Pages (from-to)G217-G226
JournalAmerican Journal of Physiology - Gastrointestinal and Liver Physiology
Volume320
Issue number2
DOIs
StatePublished - 2021

Keywords

  • Achalasia
  • Eosinophilic esophagitis
  • Gastroesophageal reflux disease
  • Peristaltic work
  • Scleroderma

ASJC Scopus subject areas

  • Physiology
  • Hepatology
  • Gastroenterology
  • Physiology (medical)

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