食管黏膜在食团运输中作用的模拟研究。
Simulation studies of the role of esophageal mucosa in bolus transport.
作者信息
Kou Wenjun, Pandolfino John E, Kahrilas Peter J, Patankar Neelesh A
机构信息
Theoretical and Applied Mechanics, Northwestern University, 2145 Sheridan Road, Evanston, IL, 60208, USA.
Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 North Saint Clair Street, 14th Floor, Chicago, IL, 60611, USA.
出版信息
Biomech Model Mechanobiol. 2017 Jun;16(3):1001-1009. doi: 10.1007/s10237-016-0867-1. Epub 2017 Jan 3.
Based on a fully coupled computational model for esophageal transport, we analyzed the role of the mucosa (including the submucosa) in esophageal bolus transport and how bolus transport is affected by mucosal stiffness. Two groups of studies were conducted using a computational model. In the first group, a base case that represents normal esophageal transport and two hypothetical cases were simulated: (1) esophageal mucosa replaced by muscle and (2) esophagus without mucosa. For the base case, the geometric configuration of the esophageal wall was examined and the mechanical role of mucosa was analyzed. For the hypothetical cases, the pressure field and transport features were examined. In the second group of studies, cases with mucosa of varying stiffness were simulated. Overall transport characteristics were examined, and both pressure and geometry were analyzed. Results show that a compliant mucosa helped accommodate the incoming bolus and lubricate the moving bolus. Bolus transport was marginally achieved without mucosa or with mucosa replaced by muscle. A stiff mucosa greatly impaired bolus transport due to the lowered esophageal distensibility and increased luminal pressure. We conclude that mucosa is essential for normal esophageal transport function. Mechanically stiffened mucosa reduces the distensibility of the esophagus by obstructing luminal opening and bolus transport. Mucosal stiffening may be relevant in diseases characterized by reduced esophageal distensibility, elevated intrabolus pressure, and/or hypertensive muscle contraction such as eosinophilic esophagitis and jackhammer esophagus.
基于一个用于食管运输的完全耦合计算模型,我们分析了黏膜(包括黏膜下层)在食管食团运输中的作用,以及食团运输如何受到黏膜硬度的影响。使用计算模型进行了两组研究。在第一组中,模拟了一个代表正常食管运输的基础案例和两个假设案例:(1)食管黏膜被肌肉替代;(2)没有黏膜的食管。对于基础案例,研究了食管壁的几何构型并分析了黏膜的力学作用。对于假设案例,研究了压力场和运输特征。在第二组研究中,模拟了具有不同硬度黏膜的案例。研究了整体运输特征,并分析了压力和几何形状。结果表明,顺应性良好的黏膜有助于容纳进入的食团并润滑移动的食团。没有黏膜或黏膜被肌肉替代时,食团运输只能勉强实现。由于食管扩张性降低和管腔内压力增加,僵硬的黏膜极大地损害了食团运输。我们得出结论,黏膜对于正常的食管运输功能至关重要。机械性变硬的黏膜通过阻碍管腔开放和食团运输降低了食管的扩张性。黏膜变硬可能与以食管扩张性降低、食团内压力升高和/或肌肉收缩亢进为特征的疾病有关,如嗜酸性食管炎和食管强力收缩症。