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Sawada A, Lei WY, Zhang M, Lee C, Ustaoglu A, Chen CL, Sifrim D. Esophageal mucosal sensory nerves and potential mechanoreceptors in patients with ineffective esophageal motility. Neurogastroenterol Motil 2022; 34:e14205. [PMID: 34152070 DOI: 10.1111/nmo.14205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Ineffective esophageal motility (IEM) is the most common motility disorder. However, little is known about its pathophysiology. Vagal afferent nerves convey esophageal intraluminal bolus information to solitary nucleus, which is likely to be involved with esophageal primary and secondary peristalsis (SP). We hypothesized that altered mucosal sensory afferents underlie the pathogenesis of IEM. METHODS We prospectively collected esophageal biopsies from 38 patients with proton pump inhibitor-refractory reflux symptoms from January to December 2019. All patients underwent high-resolution manometry for the evaluation of primary and secondary peristalsis, and off-PPI 24-h impedance-pH studies. Biopsies were analyzed using immunohistochemistry for identification of calcitonin gene-related peptide-immunoreactive (CGRP-IR) nerves and qPCR for mRNA expression of potential mechanoreceptors. KEY RESULTS Overall 32 patients were finally analyzed which consisted of 11 patients with normal motility and 21 patients with IEM. The position of mucosal CGRP-IR nerves from the esophageal lumen did not differ between the two groups (the proximal esophagus (p = 0.52), the mid-esophagus (p = 0.92), the distal esophagus (p = 0.29)) with the similar reflux profile. No difference was seen in the position of CGRP-IR nerves between patients with successful triggering of SP and those unable to trigger SP. There was also no difference in mRNA expression of each potential mechanoreceptors (TRPA1, TRPV1, TRPV4, ASIC1, ASIC3) between the two groups. CONCLUSIONS AND INFERENCES Our study showed that mucosal sensory afferents nerve position and mRNA expression of potential mechanoreceptors did not correlate to weak esophageal contraction.
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Affiliation(s)
- Akinari Sawada
- Wingate Institute of Neurogastroenterology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Wei-Yi Lei
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Mengyu Zhang
- Wingate Institute of Neurogastroenterology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chung Lee
- Wingate Institute of Neurogastroenterology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ahsen Ustaoglu
- Wingate Institute of Neurogastroenterology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chien-Lin Chen
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Daniel Sifrim
- Wingate Institute of Neurogastroenterology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Lei WY, Liu TT, Wang JH, Yi CH, Hung JS, Wong MW, Gyawali CP, Chen CL. Impact of ineffective esophageal motility on secondary peristalsis: Studies with high-resolution manometry. Neurogastroenterol Motil 2021; 33:e14024. [PMID: 33174275 DOI: 10.1111/nmo.14024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/30/2020] [Accepted: 10/13/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND/AIM The aim was to investigate whether there is a difference in secondary peristalsis on high-resolution manometry (HRM) among gastroesophageal reflux disease (GERD) patients with and without ineffective esophageal motility (IEM), and healthy individuals. METHODS Twenty-eight GERD patients and seventeen healthy controls were included. Secondary peristalsis was stimulated by a rapid injection of 20 ml air in mid-esophagus. We compared HRM metrics and the response and effective rate of triggering secondary peristalsis between patients with and without IEM and healthy controls. RESULTS Sixteen patients had IEM, and the remaining 12 had normal manometry. By triggering of secondary peristalsis, patients without IEM and healthy controls had significantly higher distal contractile integral (DCI) values than IEM patients (p = 0.006). A successful secondary peristalsis was triggered more frequently in healthy controls than in GERD patients with normal peristalsis or IEM (56.9% vs. 20.2% vs. 9.1%, all p < 0.001). The effective rate which determined as DCI > 450 mm Hg.cm.s was higher in healthy controls compared to patients with normal peristalsis (36.5% vs. 19.4%, p < 0.001) and IEM (36.5% vs. 6.3%, p < 0.001). Patients with IEM had lower successful triggering response (9.1% vs. 20.2%) and effective secondary peristalsis (6.3% vs. 19.4%) compared with patients without IEM (p < 0.001). CONCLUSIONS Our work has demonstrated that GERD patients, in particular those with IEM, have significant defects in the triggering of secondary peristalsis on HRM. HRM helps characterize esophageal secondary peristalsis which exhibits differently in patients with and without IEM.
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Affiliation(s)
- Wei-Yi Lei
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Tso-Tsai Liu
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Chih-Hsun Yi
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Jui-Sheng Hung
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Ming-Wun Wong
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | | | - Chien-Lin Chen
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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Yoshizaki T, Obata D, Ueda C, Katayama N, Aoki Y, Okamoto N, Hashimura H, Matsumoto M, Takagi M, Ikeoka S, Yoshida R, Momose K, Eguchi T, Yamashita H, Okada A. Feasibility of the lidocaine injection method during esophageal endoscopic submucosal dissection. JGH Open 2020; 4:251-255. [PMID: 32280773 PMCID: PMC7144770 DOI: 10.1002/jgh3.12257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/19/2019] [Accepted: 08/27/2019] [Indexed: 01/15/2023]
Abstract
Background and Aim Esophageal endoscopic submucosal dissection (ESD) is often technically difficult due to intraoperative body movements. The level of sedation can be increased to suppress body movements, but this may not be successful in all cases. Using local analgesics for submucosal injection during ESD may aid in conscious sedation. This study evaluated the feasibility of the lidocaine injection method (LIM) during esophageal ESD. Methods Twenty‐nine patients with superficial esophageal cancer were enrolled in this study at Osaka Saiseikai Nakatsu Hospital, and 1% lidocaine + 0.4% hyaluronate sodium was injected into the submucosa underneath the lesion during esophageal ESD. The main outcome was body movements that disturbed the procedure. Results Most patients were male (90%), with a median age of 70 years (interquartile range [IQR]: 66–75 years old), and the median lesion size was 17 mm (IQR: 12–21 mm). The median injection volume of lidocaine was 70 mg (IQR: 55–79 mg). All lesions were successfully removed en bloc. In all cases, there were no body movements that disturbed the procedure. Regarding adverse events of sedation, five patients (17%) had hypotension, four patients (14%) had bradycardia, and seven patients (24%) had hypoxemia during ESD. Convulsions or arrhythmia as adverse events associated with lidocaine were not observed. Conclusions Esophageal ESD with LIM did not cause body movements that disturbed the procedure. LIM may help create a stable conscious sedation method for esophageal ESD.
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Affiliation(s)
- Tetsuya Yoshizaki
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan
| | - Daisuke Obata
- Department of Gastroenterology and Hepatology Kobe Red Cross Hospital Kobe Japan
| | - Chise Ueda
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan.,Department of Gastroenterology and Hepatology Kobe University School of Medicine Kobe Japan
| | - Norio Katayama
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan
| | - Yasuhiro Aoki
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan
| | - Norihiro Okamoto
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan
| | - Hiroki Hashimura
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan
| | - Masanori Matsumoto
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan
| | - Megumi Takagi
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan
| | - Seitaro Ikeoka
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan
| | - Ryutaro Yoshida
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan.,Department of Gastroenterology and Hepatology Kobe University School of Medicine Kobe Japan
| | - Kenji Momose
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan
| | - Takaaki Eguchi
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan
| | - Hiroshi Yamashita
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan
| | - Akihiko Okada
- Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital Osaka Japan
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Intraoperative assessment of esophageal motility using FLIP during myotomy for achalasia. Surg Endosc 2019; 34:2593-2600. [PMID: 31376012 DOI: 10.1007/s00464-019-07028-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The functional luminal imaging probe (FLIP) can evaluate esophagogastric junction (EGJ) distensibility and esophageal peristalsis in real time. FLIP measurements performed during diagnostic endoscopy can accurately discriminate between healthy controls and patients with achalasia based on EGJ-distensibility and distinct motility patterns termed repetitive antegrade contractions (RACs) and repetitive retrograde contractions (RRCs). We sought to evaluate real-time motility changes in patients undergoing surgical myotomy for achalasia. METHODS FLIP measurements using a stepwise volumetric distention protocol were performed at three time points during assessment and performance of laparoscopic Heller myotomy and POEM: (1) During preoperative outpatient endoscopy, (2) Intraoperatively following induction of anesthesia, and (3) Intraoperatively after myotomy completion. EGJ-distensibility, contractility, RACs, and RRCs were measured. RESULTS FLIP measurements were performed in 32 patients. The EGJ-distensibility index was similar between the preoperative and initial operative measurements (1.1 vs 1.4 mm2/mmHg, p = NS). There was a significant increase in distensibility following surgical myotomy (1.4 to 4.7 mm2/mmHg, p < 0.01). Intraoperative contractile patterns varied between achalasia subtypes. Contractility was seen in < 20% of assessments in patients with types I and II achalasia. Type III patients demonstrated contractility in 100% of assessments, with 70% exhibiting RRCs and 60% RACs. There was a reduction in the frequency of RRC presence (70% to 20%), and contractile vigor (80% to 0% of patients with lumen occluding contractions) in type III patients following surgical myotomy. CONCLUSIONS This first report of real-time intraoperative measurement of esophageal motility using FLIP demonstrates the feasibility of such assessments during surgical myotomy for achalasia. Patients with type I and II achalasia exhibited rare intraoperative contractility, while the presence of motility was the norm in those with type III. Patients with type III achalasia demonstrated an immediate reduction in repetitive contraction motility patterns and contractile vigor following myotomy.
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Lei WY, Hung JS, Yi CH, Liu TT, Wong MW, Chen CL. Effects of esophageal acid infusion vs mosapride on distension-induced secondary peristalsis in humans. Kaohsiung J Med Sci 2019; 35:310-314. [PMID: 30897296 DOI: 10.1002/kjm2.12059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 02/25/2019] [Indexed: 11/08/2022] Open
Abstract
Secondary peristalsis contributes to the clearance of the refluxate from the esophagus. Acute administration of 5-hydroxytryptamine 4 (5-HT4 ) receptors agonist, mosapride or esophageal infusion of hydrochloric acid (HCl) facilitates secondary peristalsis. The aim of this study was to determine whether esophageal acid infusion and administration of mosapride had different effects on secondary peristalsis. Secondary peristalsis was performed with esophageal distension with rapid and slow air injections in 16 healthy subjects. We performed two separate sessions with HCl (0.1 N) and 40 mg oral mosapride to compare their influence on secondary peristaltic parameters. The threshold volume of secondary peristalsis was significantly lower with HCl infusion than mosapride (P = 0.01) by slow air injections. The threshold volume to generate secondary peristalsis was significantly lower with HCl infusion than mosapride (P = 0.002) by rapid air injections. More secondary peristalsis was trigged by rapid air injections after HCl infusion than mosapride (P = 0.003). Infusion of HCl or mosapride administration has similar effects on peristaltic wave amplitude and duration of primary and secondary peristalsis. Acute esophageal acid infusion can induce greater mechanosensitivity to distension-induced secondary peristalsis than 5-HT4 receptors agonist mosapride. The data suggest that acid-sensitive afferents are more likely to contribute to sensory modulation of esophageal secondary peristalsis; however, the motility aspects of secondary peristalsis are comparable between acute esophageal acidification and 5-HT4 receptors activation via mosapride.
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Affiliation(s)
- Wei-Yi Lei
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.,Institute of Medical Sciences, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jui-Sheng Hung
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Chih-Hsun Yi
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Tso-Tsai Liu
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Ming-Wun Wong
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Chien-Lin Chen
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.,Institute of Medical Sciences, College of Medicine, Tzu Chi University, Hualien, Taiwan
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Lei WY, Hung JS, Liu TT, Yi CH, Chen CL. Altered oesophageal mechanosensitivity of secondary peristalsis as a pathophysiological marker in patients with globus sensation. Clin Otolaryngol 2017; 43:306-311. [PMID: 28881108 DOI: 10.1111/coa.12978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Secondary peristalsis is important for clearance of retained food bolus and refluxate from the oesophagus. We aimed to investigate whether patients with globus sensation have altered physiological characteristics of secondary peristalsis. DESIGN Prospective case-controlled study SETTING: Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan. PARTICIPANTS Seventeen globus patients and 18 healthy controls. MAIN OUTCOME MEASURES After a baseline recording of primary peristalsis, secondary peristalsis was stimulated with slow and rapid mid-oesophageal injections of air. Distension thresholds and peristaltic activities of secondary peristalsis were analysed and compared between the patients and healthy controls. RESULTS The threshold volume for generating secondary peristalsis during slow air distension did not differ between the patient and control groups (P = .55). The threshold volume for generating secondary peristalsis during rapid air distension was significantly greater in patients with globus than healthy controls (7.0 ± 0.9 vs 5.0 ± 0.3 mL, P = .04). Secondary peristalsis was triggered less frequently in globus patients as compared with healthy control after rapid air distension (40% [30%-65%] vs 60% [60%-83%], P = .001). There was no difference in any of peristaltic parameters for primary and secondary peristalsis between the groups. CONCLUSIONS Our work identifies functional defects of oesophageal secondary peristalsis in patients with globus sensation and such defects are characterised with defective triggering of secondary peristalsis during rapid air distension. Whether current findings have therapeutic implication in the management of patients with globus sensation warrants further investigation.
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Affiliation(s)
- W-Y Lei
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan
| | - J-S Hung
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan
| | - T-T Liu
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan
| | - C-H Yi
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan
| | - C-L Chen
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan
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Yi CH, Lei WY, Hung JS, Liu TT, Orr WC, Chen CL. Relevance of sleep disturbance to the integrity and characteristics of secondary peristalsis in patients with gastroesophageal reflux disease. Scand J Gastroenterol 2017; 52:136-142. [PMID: 27608729 DOI: 10.1080/00365521.2016.1235225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Sleep disturbance is common in patients with gastroesophageal reflux disease (GERD). Secondary peristalsis is important for clearance of the refluxate from the esophagus. We aimed to test the hypothesis whether secondary peristalsis is impaired in GERD patients with sleep disturbance. METHODS Secondary peristalsis was stimulated with slow and rapid air injections into mid-esophagus in 8 age-matched health controls and 41 patients with GERD. Sleep disturbance was assessed by the Pittsburg Sleep Quality Index (PSQI). Objective sleep measures were assessed by ambulatory actigraphy. RESULTS The threshold volume for inducing secondary peristalsis during slow air injection was significantly higher in GERD patients with sleep disturbance than healthy controls (14.3 ± 1.2 vs. 8.9 ± 0.5 mL, p < .05). GERD patients with sleep disturbance had higher threshold volume of secondary peristalsis during rapid air injection than GERD patients without sleep disturbance (5.1 ± 0.4 vs. 3.9 ± 0.2 mL, p < .05) and healthy controls (5.1 ± 0.4 vs. 3.6 ± 0.2 mL, p < .05). There was a negative correlation between PSQI score and peristaltic frequency during rapid air injection (r = -.39, p = .01). Secondary peristaltic amplitude during rapid air injection was negatively correlated with wake after sleep onset (r = -.34, p = .04). CONCLUSIONS Sleep disturbance is associated with secondary peristaltic response to distension-induced esophageal stimulation in patients with GERD. Our study suggests that sleep disturbance per se may adversely influence the effectiveness of esophageal peristalsis and bolus clearance during sleep in patients with GERD.
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Affiliation(s)
- Chih-Hsun Yi
- a Department of Medicine , Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University , Hualien , Taiwan
| | - Wei-Yi Lei
- a Department of Medicine , Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University , Hualien , Taiwan
| | - Jui-Sheng Hung
- a Department of Medicine , Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University , Hualien , Taiwan
| | - Tso-Tsai Liu
- a Department of Medicine , Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University , Hualien , Taiwan
| | - William C Orr
- b Department of Physiology, Lynn Institute for Healthcare Research , University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
| | - Chien-Lin Chen
- a Department of Medicine , Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University , Hualien , Taiwan
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Yi CH, Lei WY, Hung JS, Liu TT, Chen CL. Effects of prucalopride on esophageal secondary peristalsis in humans. Clin Transl Gastroenterol 2016; 7:e202. [PMID: 27831544 PMCID: PMC5288569 DOI: 10.1038/ctg.2016.58] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 09/30/2016] [Indexed: 12/15/2022] Open
Abstract
Objectives: Prucalopride, a high-affinity 5-hydroxytrypatamine 4 (5-HT4) receptors agonist, has been shown to improve colon motility in adults. Secondary peristalsis helps the clearance of retained food bolus and refluxate from the esophagus, but the effects of prucalopride on esophageal secondary peristalsis are unknown. We aimed to assess the effects of prucalopride on distension-induced secondary peristalsis in healthy adults. Methods: Two separate sessions with prucalopride and placebo were performed in 11 healthy adults to test the effects on secondary peristalsis. Secondary peristalsis was performed with slow and rapid mid-esophageal injections of air after a baseline recording of esophageal motility. Results: Prucalopride significantly decreased the threshold volume to generate secondary peristalsis during slow air injection (9.8±1.4 vs. 14.4±0.9 ml, P=0.005) and rapid air injection (3.9±0.3 vs. 5.2±0.4 ml, P=0.008). Secondary peristalsis was generated more frequently after application of prucalopride (80% (70–100%) vs. 70% (60–73%), P=0.01). Prucalopride increased the wave amplitude of distal esophagus during slow air injection (147.9±28.5 vs. 104.2±16.8 mm Hg, P=0.048) and rapid air injection (128.0±13.3 vs. 105.7±12.3 mm Hg, P=0.016). Primary peristaltic amplitudes were also significantly increased by the application of prucalopride. Conclusions: Acute administration of prucalopride enhances mechanosensitivity of distension-induced secondary peristalsis and promotes esophageal contractility in healthy adults. Whether prucalopride could be a therapeutic option for the treatment of subjects with esophageal hypomotility needs further study.
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Affiliation(s)
- Chih-Hsun Yi
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Wei-Yi Lei
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Jui-Sheng Hung
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Tso-Tsai Liu
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Chien-Lin Chen
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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Liu TT, Yi CH, Lei WY, Hung JS, Chen CL, Orr WC. Effects of esophageal capsaicin instillation on acid induced excitation of secondary peristalsis in humans. J Gastroenterol Hepatol 2016; 31:364-9. [PMID: 26250995 DOI: 10.1111/jgh.13080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 07/29/2015] [Accepted: 08/02/2015] [Indexed: 12/09/2022]
Abstract
BACKGROUND/AIM Esophageal instillation of capsaicin or hydrochloric acid enhances secondary peristalsis. Our aim was to investigate whether intra-esophageal capsaicin infusion can influence symptom perception and physiological alteration of secondary peristalsis subsequent to acid infusion. METHODS Secondary peristalsis was induced by mid-esophagus injections of air in 18 healthy subjects. Two different sessions including esophageal infusion of hydrochloric acid (0.1 N) following pretreatment with saline or capsaicin-containing red pepper sauce were randomly performed at least one week apart. Symptoms of heartburn and secondary peristalsis were determined and compared between each study session. RESULTS The intensity of heartburn symptom subsequent to acid infusion was significantly reduced after capsaicin infusion as compared with saline infusion (54 ± 3 vs 61 ± 3; P = 0.03). Capsaicin infusion significantly increased the threshold volume of secondary peristalsis to rapid air injections subsequent to esophageal acid infusion (8.0 ± 0.5 mL vs 4.4 ± 0.3 mL; P < 0.0001). The frequency of secondary peristalsis subsequent to acid infusion was significantly decreased after capsaicin infusion as compared to saline infusion (70% [60-82.5%] vs 80% [70-90%]; P = 0.03). Capsaicin infusion significantly decreased the pressure wave amplitude of secondary peristalsis subsequent to acid infusion during rapid air injections (90.6 ± 8.7 mmHg vs 111.1 ± 11.1 mmHg; P = 0.03). CONCLUSIONS Capsaicin appears to desensitize the esophagus to acid induced excitation of secondary peristalsis in humans, which is probably mediated by rapidly adapting mucosal mechanoreceptors. High capsaicin-containing diet might attenuate normal physiological response to abrupt acid reflux by inhibiting secondary peristalsis.
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Affiliation(s)
- Tso-Tsai Liu
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Chih-Hsun Yi
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Wei-Yi Lei
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Jui-Sheng Hung
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Chien-Lin Chen
- Department of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - William C Orr
- Lynn Institute for Healthcare Research, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Carlson DA, Lin Z, Rogers M, Lin CY, Kahrilas PJ, Pandolfino JE. Utilizing functional lumen imaging probe topography to evaluate esophageal contractility during volumetric distention: a pilot study. Neurogastroenterol Motil 2015; 27:981-9. [PMID: 25898916 PMCID: PMC4478241 DOI: 10.1111/nmo.12572] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 03/24/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND The functional lumen imaging probe (FLIP) measures luminal cross-sectional area and pressure during volumetric distension. By applying novel customized software to produce FLIP topography plots, organized esophageal contractility can be visualized and analyzed. We aimed to describe the stimulus thresholds and contractile characteristics for distension-induced esophageal body contractility using FLIP topography in normal controls. METHODS Ten healthy controls were evaluated during endoscopy with FLIP. During stepwise bag distension, simultaneous intra-bag pressure and luminal diameter measurements were obtained and exported to a MatLab program to generate FLIP topography plots. The distension volume, intra-bag pressure, and maximum esophageal body diameters were measured for the onset and cessation of repetitive antegrade contractions (RACs). Contraction duration, interval, magnitude, and velocity were measured at 8 and 3-cm proximal to the esophagogastric junction. KEY RESULTS Eight of ten subjects demonstrated RACs at a median onset volume of 29 mL (IQR: 25-38.8), median intra-bag pressure of 10.7 mmHg (IQR: 8.6-15.9), and median maximum esophageal body diameter of 18.5 mm (IQR: 17.5-19.6). Cessation of RACs occurred prior to completion of the distension protocol in three of the eight subjects exhibiting RACs. Values of the RAC-associated contractile metrics were also generated to characterize these events. CONCLUSIONS & INFERENCES Distension-induced esophageal contractions can be assessed utilizing FLIP topography. RACs are a common finding in asymptomatic controls in response to volume distention and have similar characteristics to secondary peristalsis and repetitive rapid swallows.
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Affiliation(s)
- DA Carlson
- Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Z Lin
- Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - M Rogers
- Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - CY Lin
- Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - PJ Kahrilas
- Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - JE Pandolfino
- Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Liu Q, Feng CC, Wang EM, Yan XJ, Chen SL. Efficacy of mosapride plus proton pump inhibitors for treatment of gastroesophageal reflux disease: A systematic review. World J Gastroenterol 2013; 19:9111-9118. [PMID: 24379638 PMCID: PMC3870566 DOI: 10.3748/wjg.v19.i47.9111] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 09/27/2013] [Accepted: 10/14/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the potential benefits of mosapride plus proton pump inhibitors (PPIs) in the treatment of gastroesophageal reflux disease.
METHODS: A literature search was performed through MEDLINE, EMBASE, and the ISI Web of Knowledge. The clinical trials that compared the benefit of mosapride plus PPI treatment with that of PPI monotherapy were analyzed. The rate of responders was evaluated by the pooled relative risk (PRR) and improvement in symptom scores was assessed by single effect size of a standardized mean, while Hedges’g was used as the effect size. Pooled effect sizes with 95%CIs were calculated using a fixed-effects model. Between-study heterogeneity was assessed using Q test and I2 analyses. In addition, studies that assessed the additional efficacy of mosapride in PPI-resistant patients were also reviewed.
RESULTS: This systematic review included information on a total of 587 patients based on 7 trials. Four trials compared the efficacy of combination therapy of mosapride plus a PPI with that of PPI monotherapy. The statistical analysis for the effect of additional mosapride showed equivocal results (PRR = 1.132; 95%CI: 0.934-1.372; P = 0.205; Hedges’g = 0.24; 95%CI: 0.03-0.46; P = 0.023). No heterogeneity and publication bias were found among the studies. Three open-labeled trials assessed the additional efficacy of mosapride in PPI-resistant patients. However, since these trials did not set the control group, the results may be considerably biased.
CONCLUSION: Mosapride combined therapy is not more effective than PPI alone as first-line therapy. Whether it is effective in PPI-resistant patients needs to be determined.
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12
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Chen CL, Yi CH, Liu TT. Influence of intraluminal acidification on esophageal secondary peristalsis in humans. Dig Dis Sci 2013; 58:1948-54. [PMID: 23392747 DOI: 10.1007/s10620-013-2584-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 01/21/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Secondary peristalsis contributes to clearance of retained refluxate or material from the esophagus. AIM The goal of our study was to investigate the effects of hydrochloric acid (HCl) on physiological characteristics of esophageal secondary peristalsis in healthy adults. METHODS After recording esophageal motility baseline for primary peristalsis, secondary peristalsis was stimulated with slow and rapid air injections in the mid-esophageal in 16 healthy subjects. Normal saline and HCl (0.1 N) were separately infused into the esophagus to test whether they had effects on secondary peristalsis. RESULTS After infusion of HCl, the threshold volume to generate secondary peristalsis was significantly decreased during rapid and slow air infusions (both P < 0.05). The frequency of secondary peristalsis was increased after HCl infusion (90 % [72.5-100 %] versus 85 % [72.5-90 %], P = 0.002). Infusion of HCl significantly increased pressure wave amplitude during rapid and slow air infusions (both P < 0.05). Infusion of saline did not affect any parameters of secondary peristalsis. The occurrence of heartburn was generated in 7 of 16 subjects after infusion of HCl with an increase in visual analogue scale score (12.5). CONCLUSIONS Our data show that acute esophageal acid infusion enhances sensitivity of distension-induced secondary peristalsis and enhances secondary peristaltic activity. The study supports the evidence of the presence of acid-sensitive afferents in the modulation of distension-induced secondary peristalsis in humans.
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Affiliation(s)
- Chien-Lin Chen
- Department of Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, 707, Sec. 3, Chung-Yang Rd, Hualien 970, Taiwan.
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Aimi M, Furuta K, Morito Y, Fukazawa K, Adachi K, Kinoshita Y. Observations of Acid Reflux and Motor Function in Distal Esophagus Using Simultaneous Measurements of Intra-esophageal pH and Pressure in 8 Directions With Novel Sensor Catheter - A Feasibility Study. J Neurogastroenterol Motil 2013; 19:42-6. [PMID: 23350046 PMCID: PMC3548125 DOI: 10.5056/jnm.2013.19.1.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 11/09/2012] [Accepted: 11/23/2012] [Indexed: 11/23/2022] Open
Abstract
Background/Aims Esophagogastric junctional lesions, such as mucosal breaks with Los Angeles grade A or B reflux esophagitis, lacerations in Mallory Weiss syndrome, and short segment Barrett's esophagus, are mainly found in the right anterior wall of the distal esophagus. Asymmetrical lower esophageal sphincter pressure and resting radial asymmetrical acid reflux may be causes of this asymmetrical distribution of reflux esophagitis and short segment Barrett's esophagus. We developed a novel pH and pressure catheter to investigate the asymmetrical distributions of pH and intra-esophageal pressure in the distal esophagus. Methods One healthy male volunteer was enrolled in this study. Acid reflux and motor function in distal esophagus was investigated using simultaneous measurements of intra-esophageal pH and pressure in 8 directions with novel sensor catheter. Results Thirty-six acid and weak acid reflux events were observed, of which 22 were circumferential refluxes with pH drops in all channels and 14 were partial refluxes with pH drops in some channels. Increase in transient circumferential intraesophageal pressure was observed just after 72.7% of the circumferential reflux and 42.9% of the partial reflux events. Conclusions Using a novel sensor catheter, 2 different types of acid reflux events were identified in the present study.
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Affiliation(s)
- Masahito Aimi
- Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Shimane, Japan
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14
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Chen CL, Liu TT, Yi CH, Orr WC. Effects of mosapride on esophageal secondary peristalsis in humans. Neurogastroenterol Motil 2011; 23:606-e249. [PMID: 21501334 DOI: 10.1111/j.1365-2982.2011.01714.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Secondary peristalsis is important for the clearance of refluxate or retained food bolus from the esophagus. Mosapride is a prokinetic agent that enhances GI motility by stimulating 5-hydroxytrypatamine(4) (5-HT(4) ) receptors, but its effects on secondary peristalsis are yet unclear in humans. We aimed to investigate the effect of a 5-HT(4) agonist mosapride on esophageal distension-induced secondary peristalsis in normal subjects. METHODS After a baseline recording esophageal motility, secondary peristalsis was generated by slow and rapid mid-esophageal injections of air in 15 healthy subjects. Two separate sessions with 40mg oral mosapride or placebo were randomly performed to test their effects on esophageal secondary peristalsis. KEY RESULTS Mosapride decreased the threshold volume for triggering secondary peristalsis during rapid air distension (4.5±0.3 vs 5.3±0.4mL; P=0.04) but not slow air distension (14.3±1.2 vs 13.3±1.3mL; P=0.41). Secondary peristalsis was triggered more frequently in response to rapid air distension after application of mosapride [100% (90-100%) vs 90% (80-100%); P=0.02]. Mosapride significantly increased pressure wave amplitudes of secondary peristalsis during slow (135.4±13.8 vs 105.0±12.9mmHg; P=0.001) and rapid air distensions (124.0±11.6 vs 95.9±14.0mmHg; P=0.002). CONCLUSIONS & INFERENCES Mosapride enhances sensitivity to distension-induced secondary peristalsis and facilitates secondary peristaltic contractility. These data provide an evidence for modulation of esophageal secondary peristalsis by the 5-HT(4) agonist mosapride, as well support for its clinical utility.
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Affiliation(s)
- C L Chen
- Department of Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
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Chen CL, Liu TT, Yi CH. Control of esophageal distension-induced secondary peristalsis by the GABA(B) agonist baclofen in humans. Neurogastroenterol Motil 2011; 23:612-e250. [PMID: 21501336 DOI: 10.1111/j.1365-2982.2011.01716.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Secondary peristalsis is important for the clearance of retained food bolus or refluxate from the esophagus. The effects of the gamma aminobutyric acid receptor type B (GABA(B) ) agonist on secondary peristalsis remain unclear in humans. We aimed to investigate the effect of a GABA(B) agonist baclofen on esophageal secondary peristalsis. METHODS After a baseline recording of esophageal motility, secondary peristalsis was generated by slow and rapid mid-esophageal injections of air in 15 healthy subjects. Two separate sessions with 40mg oral baclofen or placebo were randomly performed to test their effects on secondary peristalsis. KEY RESULTS Baclofen increased the threshold volume for triggering secondary peristalsis during slow air distension (P=0.003) and rapid air distension (P=0.002). Baclofen reduced the rate of secondary peristalsis by rapid air distension from 90% to 30% (P=0.0002). Baclofen increased basal lower esophageal sphincter pressure (P=0.03). Baclofen did not affect any of peristaltic parameters during primary or secondary peristalsis. CONCLUSIONS & INFERENCES This study provides an evidence for inhibitory modulation of esophageal secondary peristalsis by the GABA(B) agonist baclofen. Activation of secondary peristalsis is probably modulated by GABA(B) receptors; however, baclofen does not lead to any motility change in secondary peristalsis.
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Affiliation(s)
- C L Chen
- Department of Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
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