Ellison Ashton C, Kahrilas Peter J, Pandolfino John E, Carlson Dustin A
Division of Gastroenterology, Baylor University Medical Center, Dallas, TX, USA.
Department of Medicine, Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
J Neurogastroenterol Motil. 2024 Jul 30;30(3):343-351. doi: 10.5056/jnm23051.
BACKGROUND/AIMS: Cholecystokinin (CCK) administration has been shown to reduce lower esophageal sphincter (LES) pressure in normal subjects in manometric studies. Functional luminal imaging probe (FLIP) panometry offers a method to assess esophageal motility in response to sustained distension though mechanisms related to this response remain unexplored. The aim of this study is to evaluate the effect of CCK-8 on the esophageal response to distension in asymptomatic volunteers using FLIP.
Esophageal response to distension was studied in 7 asymptomatic volunteers (mean age ± SD [27 ± 2]; 86% female) before and after CCK-8 administration in a crossover study design. During sedated endoscopy, FLIP was performed twice with CCK-8 administered via intravenous push in one of 2 protocols: during filling (n = 4) or during emptying (n = 3). Esophagogastric junction distensibility index (EGJ-DI) at 60 mL fill volume and esophageal body contractile response patterns were analyzed.
During the baseline FLIP study, all subjects had a contractile response with repetitive antegrade contractions both before and after CCK-8 administration. However, a sustained LES contraction or a sustained occluding contraction with esophageal shortening was observed in all subjects in the filling protocol, but in none during the emptying protocol. EGJ-DI was similar before and after CCK-8 during both filling (4.7 ± 1.9 mm/mmHg vs 4.3 ± 1.8 mm/mmHg) and emptying protocol (7.5 ± 1.4 mm/mmHg vs 6.9 ± 0.6 mm/mmHg).
While EGJ-DI appeared unaffected by CCK-8 administration in asymptomatic volunteers, CCK induced spastic-reactive contractions of the LES during distention suggesting that exogenous CCK interferes with normal LES relaxation during secondary peristalsis.
背景/目的：在人体测压研究中，已表明给予胆囊收缩素（CCK）可降低正常受试者的食管下括约肌（LES）压力。功能性腔内成像探头（FLIP）测压法提供了一种评估食管对持续扩张反应的方法，不过与该反应相关的机制仍未得到探索。本研究的目的是使用FLIP评估CCK-8对无症状志愿者食管扩张反应的影响。
在一项交叉研究设计中，对7名无症状志愿者（平均年龄±标准差[27±2]；86%为女性）在给予CCK-8之前和之后进行食管对扩张的反应研究。在镇静内镜检查期间，通过静脉推注给予CCK-8，按照2种方案之一进行2次FLIP检查：在充盈期（n = 4）或排空期（n = 3）。分析60 mL充盈量时的食管胃交界扩张性指数（EGJ-DI）和食管体收缩反应模式。
在基线FLIP研究期间，所有受试者在给予CCK-8之前和之后均有收缩反应，伴有重复性顺行收缩。然而，在充盈方案中所有受试者均观察到LES持续收缩或伴有食管缩短的持续闭塞性收缩，但在排空方案中均未观察到。在充盈期（4.7±1.9 mm/mmHg对4.3±1.8 mm/mmHg）和排空期（7.5±1.4 mm/mmHg对6.9±0.6 mm/mmHg），CCK-8前后的EGJ-DI相似。
虽然在无症状志愿者中EGJ-DI似乎不受给予CCK-8的影响，但CCK在扩张期间诱导LES痉挛性反应性收缩，表明外源性CCK在继发性蠕动期间干扰LES正常松弛。
