The possible inflammatory and immune activation in gastrointestinal mucosa of patients with post-infectious irritable bowel syndrome–functional dyspepsia. Inflammatory cells (mast cells, eosinophils, T lymphocytes, and chromaffin cells) are activated and release inflammatory factors (TNF-α, IFN-γ, IL-1/6/8, etc) and inflammatory mediators (histamine, leukotriene, platelet activating factor, 5-hydroxytryptamine [5-HT], etc) to participate in the inflammatory response, resulting in the increase of epithelial permeability through the redistribution of tight junction proteins and visceral hypersensitivity through 5-HT and increased excitability of afferent neurons. MLCK, myosin light chain kinase; HPA, hypothalamic-pituitary-adrenal; ZO-1, zonula occludens-1; DRG, dorsal root ganglion.
Hill grade on endoscopy. Grade I: presence of a prominent fold of tissue closely approximated to the shaft of the endoscope. Grade II: the fold of tissue is less prominent and there are occasional periods of opening and rapid closing around the endoscope with respiration. Grade III: the fold is barely present, and the endoscope is not tightly gripped by the tissues. Grade IV: there is no fold, and the lumen of the esophagus is open, often allowing the squamous epithelium to be viewed from below. A hiatal hernia is always present.
Hypopharyngeal multichannel intraluminal impedance and pH (HMII-pH) waveform showing no laryngopharyngeal reflux event and very low impedance baseline value in the hypopharyngeal channel. BI, baseline impedance.
Examples of high-resolution manometry (HRM) findings before and after peroral endoscopic myotomy (POEM). (A) Type I achalasia before POEM (left) with integrated relaxation pressure (IRP) 21.5 mmHg, ineffective esophageal motility (peristaltic recovery) after POEM with IRP 10.6 mmHg (right). (B) Type II achalasia before POEM (left) with IRP 32.8 mmHg, ineffective esophageal motility (peristaltic recovery) after POEM with IRP 11.7 mmHg (right). (C) Type II achalasia before POEM (left) with IRP 46.4 mmHg, ineffective esophageal motility (peristaltic recovery) after POEM with IRP 12.5 mmHg (right). (D) Type II achalasia before POEM with IRP 43.0 mmHg (left), absent contractility after POEM with IRP 14.0 mmHg (right). (E) Type II achalasia before POEM with IRP 27.3 mmHg (left), ineffective esophageal motility (peristaltic recovery) after POEM with IRP 10.8 mmHg (right). (F) Type III achalasia before POEM with IRP 30.8 mmHg (left), fragmented peristalsis after POEM with IRP 12.7 mmHg (right).
J Neurogastroenterol Motil 2021; 27(2): 149~306 
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