Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2025
Striated Muscle Contractility and Distal Esophageal Distensibility Define Novel Subtypes of Functional Dysphagia.
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Tsuru Hirotaka, Ihara Eikichi, Muta Kazumasa, Mittal Ravinder K, Zifan Ali, Wada Masafumi, Fukuya Hiroki, Hata Yoshitaka, Bai Xiaopeng, Tanaka Yoshimasa, Minoda Yosuke, Esaki Mitsuru, Ogino Haruei, Chinen Takatoshi, Ogawa Yoshihiro
Аннотация
BACKGROUND & AIMS: Functional dysphagia (FD) is a common condition that significantly affects quality of life. Although esophageal hypersensitivity is believed to contribute to FD pathogenesis, recent evidence suggests that reduced esophageal distension may play a role. This cross-sectional study aimed to explore the mechanisms underlying FD in terms of esophageal distension during primary peristalsis.
METHODS: Twenty-five patients with FD and 25 healthy participants were enrolled. All participants were assessed using high-resolution manometry with distension-contraction plots (DCPs) of peristalsis and "barium onigigography (BOG) with obstruction level (OL) system," a recently developed method. OL was graded 0 to 4, with OL0 indicating normal bolus transit and OL4 representing the most impaired bolus transit.
RESULTS: DCPs revealed 2 subtypes of FD: FD with preserved esophageal distension (FD-pED), resembling conventionally recognized FD, and FD with reduced esophageal distension (FD-rED), categorized as an esophageal motility disorder. Based on BOG, 10 of 11 patients with FD-pED exhibited OL0. Conversely, 13 of 14 patients with FD-rED exhibited OL1 to OL2 (ie, impaired bolus transit). Contractility of the striated muscle region was significantly lower in the FD-rED group than in the FD-pED and healthy groups. The amplitude of striated muscle contractility was an important determinant of distal esophageal distensibility.
CONCLUSIONS: A new subtype of FD, termed FD-rED, is proposed. Reduced contraction in the striated muscle region may contribute to reduced esophageal distension in the FD-rED. Focusing on the striated muscle region may provide a promising approach for developing new diagnoses and treatments for FD-rED.
METHODS: Twenty-five patients with FD and 25 healthy participants were enrolled. All participants were assessed using high-resolution manometry with distension-contraction plots (DCPs) of peristalsis and "barium onigigography (BOG) with obstruction level (OL) system," a recently developed method. OL was graded 0 to 4, with OL0 indicating normal bolus transit and OL4 representing the most impaired bolus transit.
RESULTS: DCPs revealed 2 subtypes of FD: FD with preserved esophageal distension (FD-pED), resembling conventionally recognized FD, and FD with reduced esophageal distension (FD-rED), categorized as an esophageal motility disorder. Based on BOG, 10 of 11 patients with FD-pED exhibited OL0. Conversely, 13 of 14 patients with FD-rED exhibited OL1 to OL2 (ie, impaired bolus transit). Contractility of the striated muscle region was significantly lower in the FD-rED group than in the FD-pED and healthy groups. The amplitude of striated muscle contractility was an important determinant of distal esophageal distensibility.
CONCLUSIONS: A new subtype of FD, termed FD-rED, is proposed. Reduced contraction in the striated muscle region may contribute to reduced esophageal distension in the FD-rED. Focusing on the striated muscle region may provide a promising approach for developing new diagnoses and treatments for FD-rED.