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The rhythm and rate of distension‐induced esophageal contractility: A physiomarker of esophageal function
Author(s) -
Carlson Dustin A.,
Kou Wenjun,
Pandolfino John E.
Publication year - 2020
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/nmo.13794
Subject(s) - achalasia , distension , medicine , contractility , asymptomatic , esophagus , contraction (grammar) , cardiology , anesthesia
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.