Novel Electrical Impedance Methodology to Understand Functional Dysphagia

了解功能性吞咽困难的新型电阻抗方法

基本信息

批准号：
10888503
负责人：
RAVINDER K. MITTAL
金额：
$ 68.22万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-15 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10888503
关键词：
Affect American Animals Area Barium swallow Biological Products Bolus Infusion Cells Cephalic Chicago Classification Deglutition Deglutition Disorders Diagnosis Distal Electrophysiology (science)Endoscopy Eosinophilic Esophagitis Esophageal Diseases Esophageal motility disorders Esophagogastric Junction Esophagus Functional disorder Funding Fundoplication Future Gastrointestinal tract structure General Population Goals Image Analysis Impairment In Vitro Infusion procedures Intestines Label Laws Length Location Manometry Manufactured football Measurement Measures Methodology Methods Modality Movement Muscle Muscle function Obstruction Operative Surgical Procedures Patients Peristalsis Pharmacology Phase Reflex action Reflux Relaxation Resistance Resolution Shapes Sturnus vulgaris Symptoms Techniques Testing Therapeutic Time Travel Ultrasonography clinical practice critical period diagnostic strategy driving force electric impedance imaging probe in vivo motor disorder novel pharmacologic pressure side effect spasticity treatment response treatment strategy

项目摘要

Summary/Abstract Dysphagia or difficulty swallowing affects 15-20% of the general population in the USA. The reason for dysphagia remains unclear in large number of patients even after extensive testing using multiple modalities such as endoscopy, barium swallow and esophageal manometry. The current method of measuring esophageal peristalsis, i.e., high resolution manometry (HRM) measures only the contraction phase of peristalsis; Chicago classification of esophageal motility disorders is based on the abnormalities in the contraction phase of peristalsis. Measuring esophageal inhibition during peristalsis has been a challenge. From a functional point of view, the purpose of the inhibition phase is the relaxation of circular and longitudinal muscle so that bolus can flow through the relaxed segment with minimal resistance. The last funding period allowed us to develop methodologies to measure the luminal CSA/esophageal distension (marker of inhibition) from the intraluminal impedance measurements; advantage of which is that one can measure luminal CSA/distension at closely spaced intervals along the entire length of the esophagus, relatively easily. Using above methodology, we found abnormalities in the distension phase of esophageal peristalsis in number of patient groups with dysphagia who have normal contraction phase of peristalsis. These patients are currently labelled as functional dysphagia and there are no proper strategies to diagnose and treat this large group of patients. The goals of our future studies are to determine, 1) the mechanism of poor distension of the esophagus in patients with functional dysphagia, 2) whether pharmacologic agents that influence the contraction phase of peristalsis have an effect on the distension phase of peristalsis in normal subjects and patients with functional dysphagia, 3) whether poor distensibility and longitudinal muscle dysfunction seen in patients with eosinophilic esophagitis is reversible following treatment with a newly approved biologic agent for its treatment, 4) whether Nissen fundoplication surgery leads to poor distensibility of the esophagus, and if one can predict which patient may develop dysphagia following surgery. Overall, we believe that continued studies in the above direction will lead to better diagnostic and treatment strategies for dysphagia symptom.

摘要/摘要吞咽困难或吞咽困难会影响美国15-20％的普通人群。原因即使在使用多种方式进行大量测试后，大量患者的吞咽困难仍不清楚例如内窥镜检查，钡吞咽和食管测量法。当前测量方法食管蠕动，即高分辨率测量法（HRM）仅测量的收缩阶段蠕动；食管运动障碍的芝加哥分类是基于异常蠕动的收缩阶段。在蠕动过程中测量食道抑制是一个挑战。从功能的观点，抑制阶段的目的是圆形和纵向的放松肌肉使推注可以以最小的电阻流过松弛的片段。最后的资金期允许我们开发方法来测量腔CSA/食管延伸（抑制标记）从腔内阻抗测量值；它的优点是可以测量腔相对容易地沿食管的整个长度紧密间隔的CSA/延伸。使用上述方法论，我们发现食管蠕动的延伸阶段异常患有吞咽困难的患者群体的蠕动阶段正常收缩阶段。这些患者目前是被标记为功能性吞咽困难，没有适当的策略来诊断和治疗这一大组患者。我们未来研究的目标是确定，1）功能性吞咽困难患者的食道，2）蠕动的收缩阶段对正常受试者的蠕动的延伸阶段和功能性吞咽困难的患者3）是否在在用新认可的生物学剂治疗后，患有嗜酸性食管炎的患者是可逆的它的治疗，4）Nissen底折手术是否导致食道差的可扩张性差，以及一个是否导致可以预测哪个患者可能会在手术后出现吞咽困难。总体而言，我们认为继续研究在上述方向上，将导致吞咽困难症状的更好的诊断和治疗策略。