Mechanical Characteristics of Distension-Evoked Peristaltic Contractions in the Esophagus of Systemic Sclerosis Patients

Gregersen, Hans; Villadsen, Gerda Elisabeth; Liao, Donghua

doi:10.1007/s10620-011-1777-9

Cited by 21 publications

(36 citation statements)

References 24 publications

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“…Thus, greater the duration of the disease, the greater is the binding accounting for the progressive nature of GIT involvement in SSc. Similar results were shown in a study wherein esophageal stiffness and impaired muscle function on manometry correlated with disease duration (12).…”

Section: Discussionsupporting

confidence: 87%

Role of muscarinic-3 receptor antibody in systemic sclerosis: correlation with disease duration and effects of IVIG

Kumar

Singh

Kedika

et al. 2016

American Journal of Physiology-Gastrointestinal and Liver Physi

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Gastrointestinal dysmotility in systemic sclerosis (SSc) is associated with autoantibodies against muscarinic-3 receptor (M3-R). We investigated the temporal course of the site of action of these autoantibodies at the myenteric neurons (MN) vs. the smooth muscle (SM) M3-R in relation to disease duration, and determined the role of intravenous immunoglobulin (IVIG) in reversing these changes. Immunoglobulins purified from SSc patients (SScIgG) were used to assess their differential binding to MN and SM (from rat colon) employing immunohistochemistry (IHC). Effect of SScIgG on neural and direct muscle contraction was determined by cholinergic nerve stimulation and bethanechol-induced SM contraction. Effects of IVIG and its antigen-binding fragment F(ab')2 on SScIgG binding were studied by enzyme-linked immunosorbent assay (ELISA) of rat colonic longitudinal SM myenteric plexus (LSMMP) lysate and to second extracellular loop peptide of M3-R (M3-RL2). SScIgG from all patients demonstrated significantly higher binding to MN than to SM. With progression of SSc duration, binding at MN and SM increased in a linear fashion with a correlation coefficient of 0.696 and 0.726, respectively (P < 0.05). SScIgG-mediated attenuation of neural and direct SM contraction also increased with disease duration. ELISA analysis revealed that IVIG and F(ab')2 significantly reduced SScIgG binding to LSMMP lysate and M3-RL2. Dysmotility in SSc occurs sequentially, beginning with SScIgG-induced blockage of cholinergic neurotransmission (neuropathy), which progresses to inhibition of acetylcholine action at the SM cell (myopathy). IVIG reverses this cholinergic dysfunction at the neural and myogenic receptors by anti-idiotypic neutralization of SScIgG.

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Section: Discussionsupporting

confidence: 87%

Role of muscarinic-3 receptor antibody in systemic sclerosis: correlation with disease duration and effects of IVIG

Kumar

Singh

Kedika

et al. 2016

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…The combined impedance planimetry and manometry technology with measurement of pressure–cross‐sectional area (P–CSA) relations of the distending bag provides the needed data in vivo for force–deformation analysis in the esophagus . In our recent studies, we made a first attempt of applying P–CSA recordings to study the mechanical energy output of esophageal secondary peristaltic contractions in healthy volunteers and in patients with systemic sclerosis (SS) . In a recent study done using cardiac pump function analysis, we found that SS patients had different P–CSA loop shapes with smaller work output.…”

Section: Introductionmentioning

confidence: 99%

Distension‐evoked motility analysis in human esophagus

Liao

Villadsen

Gregersen

2013

Neurogastroenterology Motil

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Esophageal muscle properties during peristalsis can be assessed in vivo in terms of mechanical energy output parameters. Butylscopolamine impaired muscle contraction which could be detected as altered contraction parameters. The analysis can be further used as an adjunct tool of the combined manometry and impedance planimetry recordings to derive advanced esophageal motor function parameters for studying the physiological and pathophysiological mechanical consequences of esophageal contractions.

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“…Furthermore, tension–stretch ratio loops in patients with systemic sclerosis were shifted to the left, indicative of a stiffer wall in patients. Lower contraction amplitudes and smaller P‐CSA loops resulted in lower work output, power output, Δ tension, and contraction velocity for the patients compared to healthy subjects . These studies clearly demonstrated the usefulness of loop analysis. Force–velocity and force–power relations have been demonstrated in the normal and diseased esophagus.…”

Section: Application Of Cardiac Muscle Concepts To the Esophagusmentioning

confidence: 53%

Pathophysiology and treatment of achalasia in a muscle mechanical perspective

Gregersen

Lo²

2018

Annals of the New York Academy of Sciences

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This review provides a biomechanical perspective on the pathophysiology and treatment of achalasia. The esophagus is efficient in transporting ingested material to the stomach in healthy subjects. A fine balance exists between the peristaltic forces generated in the esophageal body (which herein is defined as the preload) and the resistance in the outlet, the esophago-gastric junction (which is defined as the afterload). Achalasia is a rare esophageal disease that progressively over many years challenges esophageal efficacy. Clinical features and current literature are interpreted using well-known muscle mechanics models and terms from cardiac mechanophysiology. The preload, afterload, length-tension, and strain softening concepts in particular are useful for understanding the remodeling induced by achalasia. The concepts are also useful in understanding the treatment that aim to reduce the lower esophageal sphincter pressure that does not relax sufficiently in achalasia. These treatments cover endoscopic or laparoscopic myotomy, pneumatic balloon dilation, and Botox injections. In addition to the intended reduction of the afterload for aboral transport of ingested materials, the treatments tend to induce gastroesophageal reflux in some patients because they obliterate an important component in the reflux barrier.

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Mechanical Characteristics of Distension-Evoked Peristaltic Contractions in the Esophagus of Systemic Sclerosis Patients

Cited by 21 publications

References 24 publications

Role of muscarinic-3 receptor antibody in systemic sclerosis: correlation with disease duration and effects of IVIG

Role of muscarinic-3 receptor antibody in systemic sclerosis: correlation with disease duration and effects of IVIG

Distension‐evoked motility analysis in human esophagus

Pathophysiology and treatment of achalasia in a muscle mechanical perspective

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