A mechanics--based perspective on the function of human sphincters during functional luminal imaging probe manometry

TL;DR

This paper offers a mechanical perspective on human sphincters' function during FLIP testing, explaining pressure-CSA loop patterns through muscle relaxation and contraction mechanics, aiding in diagnostics.

Contribution

It introduces a mechanical model explaining pressure-CSA loop patterns in sphincters, linking them to specific muscle activity mechanisms, which enhances understanding of sphincter function.

Findings

Two pressure-CSA loop patterns identified: NSL and PSL.

Loop type correlates with underlying muscle relaxation and contraction mechanisms.

Provides a basis for distinguishing normal and abnormal sphincter phenotypes.

Abstract

Functional luminal imaging probe (FLIP) is used to measure cross-sectional area (CSA) and pressure at sphincters. It consists of a catheter surrounded by a fluid filled cylindrical bag, closed on both ends. Plotting the pressure-CSA hysteresis of a sphincter during a contraction cycle, which is available through FLIP testing, offers information on its functionality, and can provide diagnostic insights. However, limited work has been done to explain the mechanics of these pressure-CSA loops. This work presents a consolidated picture of pressure-CSA loops of different sphincters. Clinical data reveal that although sphincters have a similar purpose (controlling the flow of liquids and solids by opening and closing), two different pressure-CSA loop patterns emerge: negative slope loop (NSL) and positive slope loop (PSL). We show that the loop type is the result of an interplay between (or lack thereof) two mechanical modes: (i) neurogenic mediated relaxation of the sphincter muscle and (ii) muscle contraction proximal to the sphincter which causes mechanical distention. We conclude that sphincters which only function through mechanism (i) exhibition NSL whereas sphincters which open as a result of both (i) and (ii) display a PSL. This work provides a fundamental mechanical understanding of human sphincters. This can be used to identify normal and abnormal phenotypes for the different sphincters and help in creating physiomarkers based on work calculation.