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Manabe N, Wada M, Takeda T, Bukeo E, Tsuru H, Hojo M, Fujita M, Ihara E, Nagahara A, Kamiya T. A review of recent developments in the imaging of disorders of gut-brain interaction. J Smooth Muscle Res 2025; 61:11-19. [PMID: 39924188 PMCID: PMC11807775 DOI: 10.1540/jsmr.61.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2024] [Accepted: 01/10/2025] [Indexed: 02/11/2025] Open
Abstract
A number of factors have been recently associated with the development of disorders of gut-brain interaction (DGBI), including genetic predisposition, early-life environment, intestinal microbiota, infection, microinflammation, and increased mucosal permeability. In addition, impaired gastrointestinal motility is important not only as a cause of DGBI but also as a consequent final phenotype. Gastrointestinal motor measurements are the predominant method for the assessment of and therapeutic intervention into motor abnormalities. As such, these measurements should be considered for DGBI patients who do not respond to first-line approaches such as behavioral therapy, dietary modifications, and pharmacotherapy. This comprehensive review focuses on the functional changes in the upper gastrointestinal tract caused by DGBI and describes ongoing attempts to develop imaging modalities to assess these dysfunctions in the esophageal and gastric regions. Recent advances in imaging techniques could help elucidate the pathophysiology of DGBI, with exciting potential for research and clinical practice.
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Affiliation(s)
- Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of
Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, 2-6-1 Nakasange,
Kita-ku, Okayama 700-8505, Japan
| | - Masafumi Wada
- Department of Medicine and Bioregulatory Science, Graduate
School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi,
Fukuoka 812-8582, Japan
| | - Tsutomu Takeda
- Department of Gastroenterology, Juntendo University Faculty
of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
- Department of Pathophysiological Research and Therapeutics
for Gastrointestinal Diseases, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo
113-8421, Japan
| | - Emiko Bukeo
- Division of Endoscopy and Ultrasonography, Department of
Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, 2-6-1 Nakasange,
Kita-ku, Okayama 700-8505, Japan
| | - Hirotaka Tsuru
- Department of Medicine and Bioregulatory Science, Graduate
School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi,
Fukuoka 812-8582, Japan
| | - Mariko Hojo
- Department of Gastroenterology, Juntendo University Faculty
of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
- Department of Pathophysiological Research and Therapeutics
for Gastrointestinal Diseases, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo
113-8421, Japan
| | - Minoru Fujita
- Division of Endoscopy and Ultrasonography, Department of
Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, 2-6-1 Nakasange,
Kita-ku, Okayama 700-8505, Japan
| | - Eikichi Ihara
- Department of Medicine and Bioregulatory Science, Graduate
School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka-shi,
Fukuoka 812-8582, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University Faculty
of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
- Department of Pathophysiological Research and Therapeutics
for Gastrointestinal Diseases, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo
113-8421, Japan
| | - Takeshi Kamiya
- Department of Medical Innovation, Nagoya City University
Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya-shi, Aichi
467-8601, Japan
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Manabe N, Nakajima A, Odaka T, Haruma K. Daikenchuto significantly improves stool consistency and lower gastrointestinal symptoms in patients with chronic constipation. JGH Open 2023; 7:182-189. [PMID: 36968570 PMCID: PMC10037039 DOI: 10.1002/jgh3.12870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/12/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND AND AIM A number of basic and clinical studies have confirmed that the traditional Japanese herbal medicine, Daikenchutou (DKT) has a pharmacological effect on cholinergic and serotonergic mechanisms with a favorable safety profile and an improving effect on lower gastrointestinal (GI) symptoms including abdominal pain or bloating. The purpose of this study is to evaluate the efficacy and safety of DKT on chronic constipation. METHODS This multicenter, randomized, placebo-controlled, double-blinded clinical trial enrolled 67 patients with chronic constipation fulfilling Rome III criteria. After a 2-week observation period, 63 patients with persistent symptoms were finally randomized to a 4-week course of treatment with DKT or placebo. The primary endpoint consisted of a global assessment of overall treatment effect (OTE), while the secondary endpoints consisted of improvements in stool consistency, spontaneous bowel movements, lower GI symptoms related to constipation, and quality of life. Factors associated with OTE were also investigated. RESULTS After 4 weeks administration of DKT, OTE was significantly higher than placebo. No side effects were observed. Significant improvement in stool consistency and lower GI symptoms was observed in the DKT group. The improvements in lower GI symptoms as well as stool consistency were associated with OTE. OTE was higher in patients with greater improvement in lower GI symptoms with mental component summary scores close to normal before treatment. CONCLUSION DKT was effective and safe in treating chronic constipation, especially in patients having symptoms related to constipation with no impaired mental component summary score.
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Affiliation(s)
- Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory MedicineKawasaki Medical SchoolOkayamaJapan
| | - Atsushi Nakajima
- Department of Gastroenterology and HepatologyYokohama City University Graduate School of MedicineYokohamaJapan
| | - Takeo Odaka
- Odaka Internal and Gastrointestinal ClinicChibaJapan
| | - Ken Haruma
- Division of Gastroenterology, Department of Internal Medicine 2Kawasaki Medical SchoolOkayamaJapan
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Katsumata R, Manabe N, Ayaki M, Fujita M, Nakamura J, Kawamoto H, Sugihara Y, Sakae H, Hamada K, Haruma K. Differences in upper esophageal sphincter function and clinical characteristics among the three subtypes of Japanese patients with esophageal achalasia. Esophagus 2022; 19:316-323. [PMID: 34860305 DOI: 10.1007/s10388-021-00897-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The rarity of esophageal achalasia has resulted in little being known about the characteristics of its three subtypes. The upper esophageal sphincter is considered one key factor to prevent aspiration pneumonia, a serious complication of esophageal achalasia. This study aimed to reveal the subtype characteristics of esophageal achalasia and how the upper esophageal sphincter functions and relates to other clinical parameters of the disease. METHODS We retrospectively investigated the clinical records of patients diagnosed with esophageal achalasia. All participants underwent esophagogastroduodenoscopy and then, within 2 weeks, high-resolution manometry. Gastrointestinal symptoms were assessed using a previously validated self-reported questionnaire. RESULTS A total of 110 patients with esophageal achalasia were enrolled: 50 with type I, 40 with type II, and 20 with type III. Mean age at diagnosis was 54.5, 50.4, and 66.1 years for types I, II, and III, respectively. Mean resting upper esophageal sphincter pressure was 28.0, 51.8, and 43.6 mmHg for patients with types I, II, and III, respectively (p < 0.01). Patients with type III esophageal achalasia more frequently reported stomachache than those with type I (p = 0.03). A negative correlation between resting upper esophageal sphincter pressure and age was observed in all subtypes. CONCLUSIONS A negative correlation was confirmed between resting upper esophageal sphincter pressure and age in all subtypes of esophageal achalasia. Type III patients were older at diagnosis, type II patients showed higher upper esophageal sphincter pressure, and type I patients showed a lower upper esophageal sphincter pressure at the early life stage.
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Affiliation(s)
- Ryo Katsumata
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange Kita-ku, Okayama-city, Okayama, 7008505, Japan.
| | - Maki Ayaki
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange Kita-ku, Okayama-city, Okayama, 7008505, Japan
| | - Minoru Fujita
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange Kita-ku, Okayama-city, Okayama, 7008505, Japan
| | - Jun Nakamura
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange Kita-ku, Okayama-city, Okayama, 7008505, Japan
| | - Hirofumi Kawamoto
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Yuusaku Sugihara
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Hiroyuki Sakae
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Kenta Hamada
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Ken Haruma
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
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Kim JK, Son S, Suh I, Bae JS, Lim JY. Postoperative Dysphagia Aortica: Comparison with Other Dysphagia. Dysphagia 2021; 37:1112-1119. [PMID: 34546446 DOI: 10.1007/s00455-021-10370-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 09/10/2021] [Indexed: 02/06/2023]
Abstract
Dysphagia can be classified as oropharyngeal or esophageal, and functional or structural deficits of the esophagus can cause esophageal dysphagia. Dysphagia aortica (DA) is defined as dysphagia caused by extrinsic compression of the esophagus by the aorta. The aim of this study was to investigate the characteristics of DA by comparing the findings of videofluoroscopic swallowing studies (VFSS) with those of other dysphagia. Sixty-seven patients with postoperative dysphagia aortica (PDA), dysphagia after brainstem infarction (DBI), dysphagia after anterior cervical discectomy and fusion (DACDF), and subjective swallowing difficulty (SSD) without penetration and/or aspiration, who had undergone VFSS incorporating tests using 5 ml of thin and thick liquids, were included. The clinical data were collected retrospectively. The penetration-aspiration scale, functional dysphagia scale (FDS), esophageal transit time (ETT), and aortic lesion parameters (maximal diameter and distance between the lesion and the apex of the aortic arch) were assessed. The patients with PDA had higher FDS scores than the patients with SSD and lower scores than the patients with DBI did on thin liquids, while the FDS scores on thick liquids were lower in the patients with PDA than in those with DBI or DACDF. The patients with PDA had longer ETT than the other three groups. No correlation was found between the aortic lesion parameters and the VFSS findings. Although PDA has some oropharyngeal symptoms, the esophageal phase was affected mainly by PDA. After an operation on the aorta, VFSS should be considered before resuming oral feeding.
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Affiliation(s)
- Jong Keun Kim
- Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon, 35233, Republic of Korea
| | - Sangpil Son
- Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon, 35233, Republic of Korea
| | - InHyuk Suh
- Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon, 35233, Republic of Korea
| | - Jin Seok Bae
- Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon, 35233, Republic of Korea
| | - Jong Youb Lim
- Department of Rehabilitation Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon, 35233, Republic of Korea.
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Matsubara M, Manabe N, Ayaki M, Nakamura J, Murao T, Fujita M, Kuinose M, Yamatsuji T, Naomoto Y, Haruma K. Clinical significance of esophagogastroduodenoscopy in patients with esophageal motility disorders. Dig Endosc 2021; 33:753-760. [PMID: 32892432 DOI: 10.1111/den.13836] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/26/2020] [Accepted: 08/31/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The first aim of this study was to elucidate the detection rate of esophagogastroduodenoscopy (EGD) in patients complaining of dysphagia with esophageal motility disorders; the second was to clarify the useful parameters of EGD associated with esophageal motility disorders. METHODS Participants included 380 patients who underwent EGD before high-resolution manometry (HRM) for dysphagia. EGD findings were investigated according to the following five parameters: resistance when passing through the esophagogastric junction (EGJ), residue in the esophageal lumen, esophageal dilation, and spastic and nonocclusive contractions. HRM diagnoses were based on the Chicago classification (v3.0). RESULTS The percentage of abnormal EGD findings was 64.4% among patients with esophageal motility disorders, and the results differed for each esophageal motility disorder. The rate of abnormal EGD for both EGJ outflow obstruction and major disorders of peristalsis was significantly higher than that for manometrically normal subjects. On multivariate analysis, resistance when passing through EGJ, residue in the esophageal lumen, spastic and nonocclusive contraction were significantly associated with esophageal motility disorders. The sensitivity, specificity, positive predictive value, and negative predictive value of these parameters for detection of esophageal motility disorders were 75.1%, 86.6%, 84.8% and 77.8%, respectively. CONCLUSION Esophagogastric junction outflow obstruction and major disorders of peristalsis can be screened with EGD. Among several endoscopic parameters, resistance when passing through EGJ, residue in the esophageal lumen, spastic and nonocclusive contraction are considered significantly useful indicators.
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Affiliation(s)
- Masaki Matsubara
- Department of General Surgery, Kawasaki Medical School, Okayama, Japan
| | - Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Okayama, Japan
| | - Maki Ayaki
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Okayama, Japan
| | - Jun Nakamura
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Okayama, Japan
| | - Takahisa Murao
- Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Okayama, Japan
| | - Minoru Fujita
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Okayama, Japan
| | - Masahiko Kuinose
- Department of General Surgery, Kawasaki Medical School, Okayama, Japan
| | - Tomoki Yamatsuji
- Department of General Surgery, Kawasaki Medical School, Okayama, Japan
| | - Yoshio Naomoto
- Department of General Surgery, Kawasaki Medical School, Okayama, Japan
| | - Ken Haruma
- Division of Gastroenterology, Department of Internal Medicine 2, Kawasaki Medical School, Okayama, Japan
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Ahmadi N, Mbuagbaw L, Hanna WC, Finley C, Agzarian J, Wen CK, Coret M, Schieman C, Shargall Y. Development of a clinical score to distinguish malignant from benign esophageal disease in an undiagnosed patient population referred to an esophageal diagnostic assessment program. J Thorac Dis 2020; 12:191-198. [PMID: 32274084 PMCID: PMC7139012 DOI: 10.21037/jtd.2020.02.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Esophageal cancer is associated with poor prognosis. Diagnosis is often delayed, resulting in presentation with advanced disease. We developed a clinical score to predict the risk of a malignant diagnosis in symptomatic patients prior to any diagnostic tests. Methods We analyzed data from patients referred to a regional esophageal diagnostic assessment program between May 2013 and August 2016. Logistic regression was performed to identify predictors of malignancy based on patient characteristics and symptoms. Predicted probabilities were used to develop a score from 0 to 10 which was weighted according to beta coefficients for predictors in the model. Score accuracy was evaluated using a receiver operating characteristic (ROC) curve and internally validated using bootstrapping techniques. Patients were classified into low (0–2 points), medium (3–6 points), and high (7–10 points) risk groups based on their scores. Pathologic tissue diagnosis was used to assess the effectiveness of the developed score in predicting the risk of malignancy in each group. Results Of 530 patients, 363 (68%) were diagnosed with malignancy. Factors predictive of malignancy included male sex, family history of cancer and esophageal cancer, fatigue, chest/throat/back pain, melena and weight loss. These factors were allocated 1–2 points each for a total of 10 points. Low-risk patients had 70% lower chance of malignancy (RR =0.28, 95% CI: 0.21–0.38), medium-risk had 50% higher chance of malignancy (RR =1.5, 95% CI: 1.26–1.77), and high-risk patients were 8 times more likely to be diagnosed with malignancy (RR =8.2, 95% CI: 2.60–25.86). The area under the ROC curve for malignancy was 0.82 (95% CI: 0.77–0.87). Conclusions A simple score using patient characteristics and symptoms reliably distinguished malignant from benign diagnoses in a population of patients with upper gastrointestinal symptoms. This score might be useful in expediting investigations, referrals and eventual diagnosis of malignancy.
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Affiliation(s)
- Negar Ahmadi
- Division of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Centre for the Development of Best Practices in Health, Yaoundé, Cameroon
| | - Waël C Hanna
- Division of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Christian Finley
- Division of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - John Agzarian
- Division of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Chuck K Wen
- Division of Thoracic Surgery, University of British Columbia, Surrey, BC, Canada
| | - Michal Coret
- Division of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Colin Schieman
- Section of Thoracic Surgery, University of Calgary, Calgary, AB, Canada
| | - Yaron Shargall
- Division of Thoracic Surgery, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
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Nakato R, Manabe N, Hanayama K, Kusunoki H, Hata J, Haruma K. Diagnosis and treatments for oropharyngeal dysphagia: effects of capsaicin evaluated by newly developed ultrasonographic method. J Smooth Muscle Res 2020; 56:46-57. [PMID: 32581185 PMCID: PMC7324726 DOI: 10.1540/jsmr.56.46] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/01/2020] [Indexed: 11/17/2022] Open
Abstract
Oropharyngeal dysphagia (OD) is a common symptom in the older people, and may cause fatal complications such as aspiration pneumonia. However, there is no established treatment for OD. The relationship between the transient receptor potential vanilloid 1 (TRPV1) and substance P released by activated TRPV1 was recently demonstrated. Further, there are several reports showing that capsaicin, a specific agonist of TRPV1, can improve OD. Currently, the evaluation of swallowing is mainly performed by videofluoroscopic examination. However, there are no reports on the clinical application of ultrasonography using tissue Doppler imaging. In this review, we describe the pathophysiology and treatments for OD, introduce our novel US method to evaluate cervical esophageal motility, and then outline our clinical study examining the effects of capsaicin, a specific TRPV1 agonist, in older patients with OD.
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Affiliation(s)
- Rui Nakato
- Division of Endoscopy and Ultrasonography, Department
of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School,
Kurashiki, Japan
| | - Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department
of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School,
Kurashiki, Japan
| | - Kozo Hanayama
- Department of Rehabilitation Medicine, Kawasaki
Medical School, Kurashiki, Japan
| | - Hiroaki Kusunoki
- Department of General Medicine, Kawasaki Medical
School, Kurashiki, Japan
| | - Jiro Hata
- Division of Endoscopy and Ultrasonography, Department
of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School,
Kurashiki, Japan
| | - Ken Haruma
- Department of General Internal Medicine 2, Kawasaki
Medical School, Kurashiki, Japan
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Manabe N, Haruma K, Nakato R, Kusunoki H, Kamada T, Hata J. New ultrasonographic screening method for oropharyngeal dysphagia: tissue Doppler imaging. Am J Physiol Gastrointest Liver Physiol 2018; 314:G32-G38. [PMID: 28864498 DOI: 10.1152/ajpgi.00019.2017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Ultrasound tissue Doppler imaging (US-TDI) has been used to diagnose regional wall motion (WM) abnormalities in coronary artery disease but has not been applied to oropharyngeal diseases. This study aimed first to validate an US-TDI method to assess cervical esophageal (CE) WM and secondly to use the method to evaluate CE WM in patients with oropharyngeal dysphagia (OD). First, we enrolled 22 healthy men (mean age: 59.7 yr) who all underwent both US-TDI and videofluoroscopy (VF) and then esophageal high-resolution manometry (HRM) in the same week. We evaluated the reproducibility of the US-TDI and the relationship between US-TDI and other modalities (VF and HRM). Second, we enrolled 56 mild OD patients (mean age: 58.0 yr) and age- and sex-matched healthy controls. Difference in CE WM between these groups was evaluated by US-TDI. All healthy subjects underwent US-TDI, VF, and HRM successfully, with a sufficiently high reproducibility coefficient for this method, and significant correlation between US-TDI and VF/HRM parameters. US-TDI showed mean time to open CE wall and mean velocity of CE wall opening significantly differed between patients and healthy controls ( P < 0.01). In conclusion, we have developed a US-TDI method for easily assessing CE WM in daily practice and also found significant differences in CE WM between mild OD patients and healthy controls. NEW & NOTEWORTHY A new ultrasonographic screening method using tissue Doppler imaging for oropharyngeal dysphagia was found to be a reliable, reproducible, and well-tolerated method. There is a significant correlation between this new method and conventional methods. This method revealed that patients having mild symptoms of oropharyngeal dysphagia had already significantly delayed cervical esophageal wall opening.
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Affiliation(s)
- Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School , Kurashiki , Japan
| | - Ken Haruma
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center , Okayama , Japan
| | - Rui Nakato
- Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School , Kurashiki , Japan
| | - Hiroaki Kusunoki
- Department of Health Care Medicine, Kawasaki Medical School , Kurashiki , Japan
| | - Tomoari Kamada
- Department of Health Care Medicine, Kawasaki Medical School General Medical Center , Okayama , Japan
| | - Jiro Hata
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School , Kurashiki , Japan
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Nakato R, Manabe N, Kamada T, Matsumoto H, Shiotani A, Hata J, Haruma K. Age-Related Differences in Clinical Characteristics and Esophageal Motility in Patients with Dysphagia. Dysphagia 2017; 32:374-382. [PMID: 27913915 DOI: 10.1007/s00455-016-9763-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 11/22/2016] [Indexed: 12/14/2022]
Abstract
Dysphagia in elderly patients has a major effect on nutrition and quality of life (QOL). Although several studies have shown that aging itself is associated with changes in esophageal motility, the impact of these changes on dysphagia symptoms and QOL is unknown. This study assessed the manometric diagnoses of elderly patients with dysphagia compared with diagnoses in younger counterparts. Participants included 116 consecutive patients examined for dysphagia from 2007 to 2014. We divided patients into three groups by age: Group A, 66 years and older (24 men, 23 women); Group B, 45-65 years (18 men, 24 women); and Group C, 44 years and younger (15 men, 12 women). The three groups were compared in regard to symptoms, esophageal motility, and health-related QOL (HRQOL). All patients underwent esophageal manometry examination and completed a self-administered questionnaire concerning their symptoms; HRQOL assessment was based on results of the Short Form-8 General Health Survey. Symptoms rated ≥4 points on the Likert scale were defined as significant. Although all patients had dysphagia as a major symptom, more elderly patients reported globus sensation, whereas more young patients reported heartburn as the primary symptom. Manometric diagnoses were generally similar across the three groups. Ineffective esophageal motility was more prevalent in Groups A and C than in Group B, although the difference was not statistically significant. No significant differences in manometric parameters or HRQOL were detected among the three groups. Despite differences in symptom patterns, broad manometric diagnoses and impairment of HRQOL in elderly patients with dysphagia are similar to those in younger counterparts.
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Affiliation(s)
- Rui Nakato
- Department of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan.
| | - Tomoari Kamada
- Department of Health Care Medicine, Kawasaki Hospital, Kawasaki Medical School, Okayama, Japan
| | - Hideo Matsumoto
- Department of Gastroenterological Surgery, Kawasaki Medical School, Kurashiki, Japan
| | - Akiko Shiotani
- Department of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Jiro Hata
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Japan
| | - Ken Haruma
- Department of General Internal Medicine 2, Kawasaki Hospital, Kawasaki Medical School, Okayama, Japan
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