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Chien-lin Chen - One of the best experts on this subject based on the ideXlab platform.
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Effect of prucalopride on sildenafil-induced inhibition of esophageal Peristalsis in healthy adults.
Journal of gastroenterology and hepatology, 2020Co-Authors: Ming-wun Wong, Wei-yi Lei, Jui-sheng Hung, Tso-tsai Liu, Shu-wei Liang, William C Orr, Chien-lin ChenAbstract:Prucalopride, a high-affinity 5-hydroxytryptamine 4 (5-HT4 ) receptor agonist, promotes esophageal Peristalsis, while phosphodiesterase type 5 (PDE5) inhibitor sildenafil inhibits esophageal Peristalsis. The present study was aimed to evaluate whether prucalopride would augment esophageal Peristalsis subsequent to the application of sildenafil. Seventeen healthy adults underwent high resolution manometry by a catheter with one injection port located in mid-esophagus. Secondary Peristalsis was assessed by rapid air injections after water swallows. Two sessions were randomly performed including acute administration of sildenafil 50 mg after pre-treatment with prucalopride or the placebo. The frequency of primary Peristalsis subsequent to the administration of sildenafil was significantly increased by prucalopride (P = 0.02). Prucalopride also significantly increased distal contractile integral (DCI) of primary Peristalsis subsequent to the administration of sildenafil (P = 0.03). No difference in the frequency of secondary Peristalsis subsequent to the administration of sildenafil for air injects of 10 mL (P = 0.14) or 20 mL (P = 0.21) was found between prucalopride and placebo. Prucalopride didn't change DCI of secondary Peristalsis subsequent to the administration of sildenafil for air injections of 10 mL (P = 0.09) or 20 mL (P = 0.12). Prucalopride modulates sildenafil-induced inhibition of primary Peristalsis by increasing its effectiveness and peristaltic wave amplitude. Our findings suggest that activation of 5-HT4 receptors plays a role in mediating sildenafil-induced inhibition of esophageal primary Peristalsis rather than secondary Peristalsis. This article is protected by copyright. All rights reserved.
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Effects of phosphodiesterase-5 inhibitor sildenafil on esophageal secondary Peristalsis: Studies with high-resolution manometry.
Journal of Gastroenterology and Hepatology, 2020Co-Authors: Ming-wun Wong, Wei-yi Lei, Jui-sheng Hung, Tso-tsai Liu, Chao‐zong Liu, Chien-lin ChenAbstract:BACKGROUND AND AIM Secondary Peristalsis contributes to the clearance of retained refluxate from the esophagus. Sildenafil, a phosphodiesterase-5 inhibitor, inhibits primary esophageal Peristalsis, but its effects on secondary Peristalsis remain unknown. This study sought to investigate whether sildenafil could influence physiological characteristics of secondary Peristalsis by applying high-resolution manometry (HRM). METHODS Seventeen healthy volunteers (15 men and 2 women, aged 30.2 ± 6.4 years) underwent two HRM studies on separate days following the administration of either a placebo or 50 mg of sildenafil in a random order. Both studies were performed using a water-perfused HRM catheter containing one air injection channel positioned in the mid-esophagus. Secondary Peristalsis was stimulated by a rapid mid-esophageal injection of 10 or 20 mL of air 1 h after the administration of either the placebo or sildenafil. The frequency and distal contractile integral of secondary Peristalsis were then compared. RESULTS Complete secondary Peristalsis triggered by the 20-mL air injection was more frequent than observed with the 10-mL air injection (P
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Effects of esophageal acid infusion vs mosapride on distension-induced secondary Peristalsis in humans.
Kaohsiung Journal of Medical Sciences, 2019Co-Authors: Wei-yi Lei, Jui-sheng Hung, Tso-tsai Liu, Ming-wun Wong, Chien-lin ChenAbstract: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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Influence of prucalopride on esophageal secondary Peristalsis in reflux patients with ineffective motility.
Journal of Gastroenterology and Hepatology, 2018Co-Authors: Wei-yi Lei, Jui-sheng Hung, Tso-tsai Liu, Chien-lin ChenAbstract:Backgrounds/Aim Ineffective esophageal motility (IEM) is associated with gastroesophageal reflux disease (GERD). Secondary Peristalsis contributes to esophageal clearance. Prucalopride promotes secondary Peristalsis by stimulating 5-hydroxytrypatamine 4 receptors in the esophagus. We aimed to determine whether prucalopride would augment secondary Peristalsis in GERD patients with IEM. Methods After a baseline recording of primary Peristalsis, secondary Peristalsis was stimulated by slow and rapid mid-esophageal injections of air in 15 patients with IEM. Two separate sessions with 4 mg oral prucalopride or placebo were randomly performed. Results Prucalopride significantly increased primary peristaltic wave amplitude (68.1 ± 10.0 vs. 55.5 ± 8.8 mmHg, P = 0.02). The threshold volume for triggering secondary Peristalsis was significantly decreased by prucalopride during slow (9.3 ± 0.8 vs. 12.0 ± 0.8 mL; P = 0.04) and rapid air injection (4.9 ± 0.3 vs. 7.1 ± 0.1 mL; P = 0.01). Secondary Peristalsis was triggered more frequently after application of prucalopride (55% [43−70%]) than placebo (45% [33−50%]) (P = 0.008). Prucalopride didn’t change pressure wave amplitudes during slow air injection (84.6 ± 8.1 vs. 57.4 ± 13.8 mmHg; P = 0.19) or pressure wave amplitudes during rapid air injection (84.2 ± 8.6 vs. 69.5 ± 12.9 mmHg; P = 0.09). Conclusions Prucalopride enhances primary Peristalsis as well as mechanosensitivity of secondary Peristalsis with limited impact on secondary peristaltic activities in IEM patients. Our study suggests that prucalopride appears to be useful in augmenting secondary Peristalsis in patients with IEM only via sensory modulation of esophageal secondary Peristalsis.
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Altered oesophageal mechanosensitivity of secondary Peristalsis as a pathophysiological marker in patients with globus sensation.
Clinical Otolaryngology, 2017Co-Authors: Wei-yi Lei, Jui-sheng Hung, Tso-tsai Liu, Chien-lin ChenAbstract: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 17 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 analyzed 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 = 0.55). 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 = 0.04). 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 = 0.001). 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 characterized with defective triggering of secondary Peristalsis during rapid air distension. Whether current findings has therapeutic implication in the management of patients with globus sensation warrants further investigation. This article is protected by copyright. All rights reserved.
Peter J. Kahrilas - One of the best experts on this subject based on the ideXlab platform.
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Partial Recovery of Peristalsis After Myotomy for Achalasia
2017Co-Authors: Sabine Roman, Peter J. Kahrilas, Thomas B. Nealis, Nathaniel J. Soper, Gilles Poncet, Eric S. Hungness, John E. PandolfinoAbstract:Main Outcomes Measure: The integrity of Peristalsis, characterized as intact, weak contractions; frequent failed Peristalsis; or premature contractions. Results: Although peristaltic fragments were evident only in patients with type 3 achalasia before treatment, intact, weak, or frequent failed Peristalsis was encountered in 5 patients with type 1 (63%), 8 with type 2 (47%), and 4 with type 3 (80%) achalasia after myotomy. One patient with type 3 achalasia had distal esophageal spasm after treatment. In patients with a postmyotomy integrated relaxation pressure of less than 15 mm Hg, only 10 (40%) had persistent absent Peristalsis. Panesophageal pressurization disappeared after myotomy in 16 of 19 patients. In the 5 patients with postmyotomy integrated relaxation pressure of more than 15 mm Hg, 4 had weak Peristalsis and 1 had absent Peristalsis.
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partial recovery of Peristalsis after myotomy for achalasia more the rule than the exception
JAMA Surgery, 2013Co-Authors: Sabine Roman, Peter J. Kahrilas, Thomas B. Nealis, Nathaniel J. Soper, Gilles Poncet, Eric S. Hungness, Francois Mion, Frederic Nicodeme, John E. PandolfinoAbstract:Importance Although successful treatment of achalasia depends on alleviating the obstruction at the esophagogastric junction, the postintervention contractile and pressurization pattern may also play a role in outcome. Objective To determine whether myotomy that alleviates the esophagogastric junction outflow obstruction in achalasia might improve Peristalsis. Design Retrospective study from August 1, 2004, through January 30, 2012. Setting Two tertiary care hospitals in Chicago and Lyon. Patients We included 30 patients (18 male; mean age [range], 43 [17-78] years), of whom 8 had type 1 (26.6%), 17 had type 2 (56.7%), and 5 (16.7%) had type 3 achalasia according to the Chicago classification. Interventions Esophageal high-resolution manometry before and after laparoscopic or endoscopic myotomy. Main Outcomes Measure The integrity of Peristalsis, characterized as intact, weak contractions; frequent failed Peristalsis; or premature contractions. Results Although peristaltic fragments were evident only in patients with type 3 achalasia before treatment, intact, weak, or frequent failed Peristalsis was encountered in 5 patients with type 1 (63%), 8 with type 2 (47%), and 4 with type 3 (80%) achalasia after myotomy. One patient with type 3 achalasia had distal esophageal spasm after treatment. In patients with a postmyotomy integrated relaxation pressure of less than 15 mm Hg, only 10 (40%) had persistent absent Peristalsis. Panesophageal pressurization disappeared after myotomy in 16 of 19 patients. In the 5 patients with postmyotomy integrated relaxation pressure of more than 15 mm Hg, 4 had weak Peristalsis and 1 had absent Peristalsis. Conclusions and Relevance Reduction or normalization of the esophagogastric junction relaxation pressure achieved by myotomy in achalasia is associated with partial recovery of Peristalsis in some patients, suggesting that the disease process progresses from the esophagogastric junction to the esophageal body. Whether the return of Peristalsis is predictive of an improved therapeutic outcome requires further study.
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quantifying esophageal Peristalsis with high resolution manometry a study of 75 asymptomatic volunteers
American Journal of Physiology-gastrointestinal and Liver Physiology, 2006Co-Authors: Sudip K Ghosh, Qing Zhang, John E. Pandolfino, Andrew Jarosz, Nimeesh Shah, Peter J. KahrilasAbstract:The vastly enhanced spatial resolution of high-resolution manometry (HRM) makes it possible to simultaneous monitor contractile activity over the entire length of the esophagus. The aim of this investigation was to define the essential features of esophageal Peristalsis in novel HRM paradigms and establish their normative values. Ten 5-ml water swallows were recorded in each of 75 asymptomatic controls with a solid-state manometric assembly incorporating 36 circumferential sensors spaced at 1-cm intervals positioned to record from the hypopharynx to the stomach. The data set was then subjected to intensive computational analysis to distill out the essential characteristics of normal Peristalsis. Esophageal Peristalsis was conceptualized in terms of a proximal contraction, a distal contraction, and a transition zone separating the two. Each contractile segment was quantified in length and then normalized among subjects to summarize focal fluctuation of contractile amplitude and propagation velocity. Furthermore, the temporal and spatial characteristics of the transition zone separating the proximal and distal contraction were quantified. For each paradigm, graphics were developed, establishing median values along with the 5th to 95th percentile range of observed variation. In addition, the synchronization between Peristalsis and esophagogastric junction relaxation was analyzed using a novel concept of the outflow permissive pressure gradient. We performed a detailed analysis of esophageal Peristalsis aimed at quantifying its essential features and, in so doing, devised new paradigms for the quantification of peristaltic function that will hopefully optimize the utility of HRM in clinical and investigative studies.
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Absence of a Deglutitive Inhibition Equivalent with Secondary Peristalsis
American Journal of Physiology-gastrointestinal and Liver Physiology, 2004Co-Authors: John E. Pandolfino, Qing Zhang, Guoxiang Shi, Peter J. KahrilasAbstract:This study aimed to determine the interactions between closely paired swallow-induced primary Peristalsis (PP) and air injection-induced secondary Peristalsis (SP). Ten subjects (7 men, 18–42 yr) w...
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Distinct patterns of oesophageal shortening during primary Peristalsis, secondary Peristalsis and transient lower oesophageal sphincter relaxation
Neurogastroenterology and Motility, 2002Co-Authors: Guoxiang Shi, John E. Pandolfino, Raymond J. Joehl, James G. Brasseur, Peter J. KahrilasAbstract:This study characterized oesophageal shor- tening during secondary Peristalsis and transient lower oesophageal sphincter relaxation (TLOSR) in an attempt to determine its contribution to the opening mechanism. Eight healthy subjects (four males, 26 ± 1 years) had metal clips affixed at 0, +3, and +8 cm relative to the squamocolumnar junction (SCJ), defining two distal oesophageal segments. Axial clip movement was assessed with concurrent videofluo- roscopy and manometry during primary Peristalsis, secondary Peristalsis and TLOSR. Clip-defined oeso- phageal segment length change was measured at 0.5-s intervals. The magnitude of the most distal segment shortening was least with TLOSR, greatest with pri- mary Peristalsis and intermediate with secondary Peristalsis. Conversely, maximal overall oesophageal shortening during TLOSR, evidenced by SCJ move- ment, was similar to that during primary Peristalsis. In 3/12 TLOSRs, the moment of LOS opening and gas reflux was optimally imaged; SCJ excursion was 0.3 ± 0.1 cm prior to LOS opening and 1.4 ± 0.7 cm immediately after gas reflux. The segmental pattern of oesophageal shortening was distinct during primary Peristalsis, secondary Peristalsis and TLOSR. During TLOSR, significant elevation of the SCJ occurred only after LOS opening, suggesting that this was a conse- quence of oesophageal distension induced by gas reflux rather than a component of the opening mech- anism.
Jasmine L Huang - One of the best experts on this subject based on the ideXlab platform.
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esophageal aPeristalsis and lung transplant recovery of Peristalsis after transplant is associated with improved long term outcomes
The Journal of Thoracic and Cardiovascular Surgery, 2020Co-Authors: Takahiro Masuda, Sumeet K Mittal, Mate Csucska, Balazs Kovacs, Rajat Walia, Jasmine L HuangAbstract:Abstract Objective Esophageal aPeristalsis has been considered a relative contraindication for lung transplant because of a higher risk of allograft dysfunction secondary to reflux and aspiration induced by poor esophageal clearance. We previously reported that esophageal motility improves in some patients after lung transplant. We reviewed the clinical course of lung transplant recipients diagnosed with an aperistaltic esophagus on pretransplant testing. Methods We identified patients diagnosed with pretransplant aperistaltic esophagus on high-resolution manometry who underwent lung transplant. Recipients with normal esophageal motility before lung transplant were used as the propensity score–matched control group. High-resolution manometry was repeated after lung transplant, and patients with aPeristalsis were further divided into 2 subgroups: improved esophageal Peristalsis and nonimproved Peristalsis (ie, persistent aPeristalsis after lung transplant). Results Esophageal aPeristalsis was seen in 31 patients (mean age, 59.0 years; 21 men). The 1-, 3-, and 5-year post–lung transplant survivals in the aPeristalsis group were 80.6%, 51.2%, and 34.9%, respectively, which was significantly lower than in the control group (90.3%, 73.4%, and 58.8%, respectively; P = .038). Post–lung transplant high-resolution manometry was performed for 29 patients in the aPeristalsis group, 19 of whom demonstrated improved esophageal motility (65.5%). The 1-, 3-, and 5-year survivals after lung transplant of patients with recovery of Peristalsis were similar to those of the control group (89.5%, 65.0%, and 48.8%, respectively; P = 1.000), whereas the nonimproved Peristalsis group had lower survival (80.0%, 36.0%, and data unavailable, respectively; P = .012). Conclusions Esophageal aPeristalsis is not necessarily a contraindication for lung transplant. Improved Peristalsis can be expected in up to two-thirds of these patients and is associated with good outcomes.
John E. Pandolfino - One of the best experts on this subject based on the ideXlab platform.
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Partial Recovery of Peristalsis After Myotomy for Achalasia
2017Co-Authors: Sabine Roman, Peter J. Kahrilas, Thomas B. Nealis, Nathaniel J. Soper, Gilles Poncet, Eric S. Hungness, John E. PandolfinoAbstract:Main Outcomes Measure: The integrity of Peristalsis, characterized as intact, weak contractions; frequent failed Peristalsis; or premature contractions. Results: Although peristaltic fragments were evident only in patients with type 3 achalasia before treatment, intact, weak, or frequent failed Peristalsis was encountered in 5 patients with type 1 (63%), 8 with type 2 (47%), and 4 with type 3 (80%) achalasia after myotomy. One patient with type 3 achalasia had distal esophageal spasm after treatment. In patients with a postmyotomy integrated relaxation pressure of less than 15 mm Hg, only 10 (40%) had persistent absent Peristalsis. Panesophageal pressurization disappeared after myotomy in 16 of 19 patients. In the 5 patients with postmyotomy integrated relaxation pressure of more than 15 mm Hg, 4 had weak Peristalsis and 1 had absent Peristalsis.
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partial recovery of Peristalsis after myotomy for achalasia more the rule than the exception
JAMA Surgery, 2013Co-Authors: Sabine Roman, Peter J. Kahrilas, Thomas B. Nealis, Nathaniel J. Soper, Gilles Poncet, Eric S. Hungness, Francois Mion, Frederic Nicodeme, John E. PandolfinoAbstract:Importance Although successful treatment of achalasia depends on alleviating the obstruction at the esophagogastric junction, the postintervention contractile and pressurization pattern may also play a role in outcome. Objective To determine whether myotomy that alleviates the esophagogastric junction outflow obstruction in achalasia might improve Peristalsis. Design Retrospective study from August 1, 2004, through January 30, 2012. Setting Two tertiary care hospitals in Chicago and Lyon. Patients We included 30 patients (18 male; mean age [range], 43 [17-78] years), of whom 8 had type 1 (26.6%), 17 had type 2 (56.7%), and 5 (16.7%) had type 3 achalasia according to the Chicago classification. Interventions Esophageal high-resolution manometry before and after laparoscopic or endoscopic myotomy. Main Outcomes Measure The integrity of Peristalsis, characterized as intact, weak contractions; frequent failed Peristalsis; or premature contractions. Results Although peristaltic fragments were evident only in patients with type 3 achalasia before treatment, intact, weak, or frequent failed Peristalsis was encountered in 5 patients with type 1 (63%), 8 with type 2 (47%), and 4 with type 3 (80%) achalasia after myotomy. One patient with type 3 achalasia had distal esophageal spasm after treatment. In patients with a postmyotomy integrated relaxation pressure of less than 15 mm Hg, only 10 (40%) had persistent absent Peristalsis. Panesophageal pressurization disappeared after myotomy in 16 of 19 patients. In the 5 patients with postmyotomy integrated relaxation pressure of more than 15 mm Hg, 4 had weak Peristalsis and 1 had absent Peristalsis. Conclusions and Relevance Reduction or normalization of the esophagogastric junction relaxation pressure achieved by myotomy in achalasia is associated with partial recovery of Peristalsis in some patients, suggesting that the disease process progresses from the esophagogastric junction to the esophageal body. Whether the return of Peristalsis is predictive of an improved therapeutic outcome requires further study.
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quantifying esophageal Peristalsis with high resolution manometry a study of 75 asymptomatic volunteers
American Journal of Physiology-gastrointestinal and Liver Physiology, 2006Co-Authors: Sudip K Ghosh, Qing Zhang, John E. Pandolfino, Andrew Jarosz, Nimeesh Shah, Peter J. KahrilasAbstract:The vastly enhanced spatial resolution of high-resolution manometry (HRM) makes it possible to simultaneous monitor contractile activity over the entire length of the esophagus. The aim of this investigation was to define the essential features of esophageal Peristalsis in novel HRM paradigms and establish their normative values. Ten 5-ml water swallows were recorded in each of 75 asymptomatic controls with a solid-state manometric assembly incorporating 36 circumferential sensors spaced at 1-cm intervals positioned to record from the hypopharynx to the stomach. The data set was then subjected to intensive computational analysis to distill out the essential characteristics of normal Peristalsis. Esophageal Peristalsis was conceptualized in terms of a proximal contraction, a distal contraction, and a transition zone separating the two. Each contractile segment was quantified in length and then normalized among subjects to summarize focal fluctuation of contractile amplitude and propagation velocity. Furthermore, the temporal and spatial characteristics of the transition zone separating the proximal and distal contraction were quantified. For each paradigm, graphics were developed, establishing median values along with the 5th to 95th percentile range of observed variation. In addition, the synchronization between Peristalsis and esophagogastric junction relaxation was analyzed using a novel concept of the outflow permissive pressure gradient. We performed a detailed analysis of esophageal Peristalsis aimed at quantifying its essential features and, in so doing, devised new paradigms for the quantification of peristaltic function that will hopefully optimize the utility of HRM in clinical and investigative studies.
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Absence of a Deglutitive Inhibition Equivalent with Secondary Peristalsis
American Journal of Physiology-gastrointestinal and Liver Physiology, 2004Co-Authors: John E. Pandolfino, Qing Zhang, Guoxiang Shi, Peter J. KahrilasAbstract:This study aimed to determine the interactions between closely paired swallow-induced primary Peristalsis (PP) and air injection-induced secondary Peristalsis (SP). Ten subjects (7 men, 18–42 yr) w...
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Distinct patterns of oesophageal shortening during primary Peristalsis, secondary Peristalsis and transient lower oesophageal sphincter relaxation
Neurogastroenterology and Motility, 2002Co-Authors: Guoxiang Shi, John E. Pandolfino, Raymond J. Joehl, James G. Brasseur, Peter J. KahrilasAbstract:This study characterized oesophageal shor- tening during secondary Peristalsis and transient lower oesophageal sphincter relaxation (TLOSR) in an attempt to determine its contribution to the opening mechanism. Eight healthy subjects (four males, 26 ± 1 years) had metal clips affixed at 0, +3, and +8 cm relative to the squamocolumnar junction (SCJ), defining two distal oesophageal segments. Axial clip movement was assessed with concurrent videofluo- roscopy and manometry during primary Peristalsis, secondary Peristalsis and TLOSR. Clip-defined oeso- phageal segment length change was measured at 0.5-s intervals. The magnitude of the most distal segment shortening was least with TLOSR, greatest with pri- mary Peristalsis and intermediate with secondary Peristalsis. Conversely, maximal overall oesophageal shortening during TLOSR, evidenced by SCJ move- ment, was similar to that during primary Peristalsis. In 3/12 TLOSRs, the moment of LOS opening and gas reflux was optimally imaged; SCJ excursion was 0.3 ± 0.1 cm prior to LOS opening and 1.4 ± 0.7 cm immediately after gas reflux. The segmental pattern of oesophageal shortening was distinct during primary Peristalsis, secondary Peristalsis and TLOSR. During TLOSR, significant elevation of the SCJ occurred only after LOS opening, suggesting that this was a conse- quence of oesophageal distension induced by gas reflux rather than a component of the opening mech- anism.
Takahiro Masuda - One of the best experts on this subject based on the ideXlab platform.
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esophageal aPeristalsis and lung transplant recovery of Peristalsis after transplant is associated with improved long term outcomes
The Journal of Thoracic and Cardiovascular Surgery, 2020Co-Authors: Takahiro Masuda, Sumeet K Mittal, Mate Csucska, Balazs Kovacs, Rajat Walia, Jasmine L HuangAbstract:Abstract Objective Esophageal aPeristalsis has been considered a relative contraindication for lung transplant because of a higher risk of allograft dysfunction secondary to reflux and aspiration induced by poor esophageal clearance. We previously reported that esophageal motility improves in some patients after lung transplant. We reviewed the clinical course of lung transplant recipients diagnosed with an aperistaltic esophagus on pretransplant testing. Methods We identified patients diagnosed with pretransplant aperistaltic esophagus on high-resolution manometry who underwent lung transplant. Recipients with normal esophageal motility before lung transplant were used as the propensity score–matched control group. High-resolution manometry was repeated after lung transplant, and patients with aPeristalsis were further divided into 2 subgroups: improved esophageal Peristalsis and nonimproved Peristalsis (ie, persistent aPeristalsis after lung transplant). Results Esophageal aPeristalsis was seen in 31 patients (mean age, 59.0 years; 21 men). The 1-, 3-, and 5-year post–lung transplant survivals in the aPeristalsis group were 80.6%, 51.2%, and 34.9%, respectively, which was significantly lower than in the control group (90.3%, 73.4%, and 58.8%, respectively; P = .038). Post–lung transplant high-resolution manometry was performed for 29 patients in the aPeristalsis group, 19 of whom demonstrated improved esophageal motility (65.5%). The 1-, 3-, and 5-year survivals after lung transplant of patients with recovery of Peristalsis were similar to those of the control group (89.5%, 65.0%, and 48.8%, respectively; P = 1.000), whereas the nonimproved Peristalsis group had lower survival (80.0%, 36.0%, and data unavailable, respectively; P = .012). Conclusions Esophageal aPeristalsis is not necessarily a contraindication for lung transplant. Improved Peristalsis can be expected in up to two-thirds of these patients and is associated with good outcomes.
