Does premature closure of the lower esophageal sphincter explain dysphagia in patients with normal esophageal motility?

2001 ◽  
Vol 96 (9) ◽  
pp. S1-S2
Author(s):  
F AHMAD1
Keyword(s):  
Lower Esophageal Sphincter ◽  
Esophageal Motility ◽  
Premature Closure ◽  
Esophageal Sphincter

scholarly journals THE PARTICIPATION OF THE NITRERGIC PATHWAY IN INCREASED RATE OF TRANSITORY RELAXATION OF LOWER ESOPHAGEAL SPHINCTER INDUCED BY RECTAL DISTENSION IN DOGS

2014 ◽  
Vol 51 (2) ◽  
pp. 102-106 ◽  
Author(s):  
Michel Santos PALHETA ◽  
José Ronaldo Vasconcelos da GRAÇA ◽  
Armênio Aguiar dos SANTOS ◽  
Liziane Hermógenes LOPES ◽  
Raimundo Campos PALHETA JÚNIOR ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Lower Esophageal Sphincter ◽  
Esophageal Motility ◽  
Control Group ◽  
Rectal Distension ◽  
Evaluation Protocol ◽  
Lower Esophageal Sphincter Relaxation ◽  
Respective Control Group ◽  
Esophageal Sphincter ◽  
Pre Treatment

ContextThe rectal distension in dogs increases the rate of transitory lower esophageal sphincter relaxation considered the main factor causing gastroesophageal reflux.ObjectivesThe aim of this study was evaluate the participation of the nitrergic pathway in the increased transitory lower esophageal sphincter relaxation rate induced by rectal distension in anesthetized dogs.MethodsMale mongrel dogs (n = 21), weighing 10-15 kg, were fasted for 12 hours, with water ad libitum. Thereafter, they were anesthetized (ketamine 10 mg.Kg-1+ xylazine 20 mg.Kg-1), so as to carry out the esophageal motility evaluation protocol during 120 min. After a 30-minute basal period, the animals were randomly intravenous treated whith: saline solution 0.15M (1ml.Kg-1), L-NAME (3 mg.Kg-1), L-NAME (3 mg.Kg-1) + L-Arginine (200 mg.Kg-1), glibenclamide (1 mg.Kg-1) or methylene blue (3 mg.Kg-1). Forty-five min after these pre-treatments, the rectum was distended (rectal distension, 5 mL.Kg-1) or not (control) with a latex balloon, with changes in the esophageal motility recorded over 45 min. Data were analyzed using ANOVA followed by Student Newman-Keuls test.ResultsIn comparison to the respective control group, rectal distension induces an increase in transitory lower esophageal sphincter relaxation. Pre-treatment with L-NAME or methylene blue prevents (P<0.05) this phenomenon, which is reversible by L-Arginine plus L-NAME. However, pretreating with glibenclamide failed to abolish this process.ConclusionsTherefore, these experiments suggested, that rectal distension increases transitory lower esophageal sphincter relaxation in dogs via through nitrergic pathways.

Effect of prostaglandin E2 on esophageal motility in man

1975 ◽  
Vol 39 (3) ◽  
pp. 479-481 ◽  
Author(s):  
A. Mukhopadhyay ◽  
S. Rattan ◽  
R. K. Goyal
Keyword(s):  
Prostaglandin E2 ◽  
Lower Esophageal Sphincter ◽  
Esophageal Motility ◽  
Lower Esophageal Sphincter Pressure ◽  
Upper Esophageal Sphincter ◽  
The Body ◽  
Inhibitory Influence ◽  
Sphincter Pressure ◽  
Esophageal Sphincter ◽  
Peristaltic Contractions

Studies were performed to investigate the effect of prostaglandin E2 on esophageal motility in 12 healthy volunteers. PGE2 infusion caused a dose-dependent reduction in the lower esophageal sphincter pressure. The threshold dose was less than 0.05 mug-kg-1-min-1 and maximal reduction of pressure (60%) occurred with a dose of 0.4 mug-kg-1-min-1. In contrast to its effect on the lower esophageal sphincter, PGE2 did not alter the pressure in the upper esophageal sphincter. PGE2 did not influence resting esophageal pressures; the amplitude of peristaltic contractions was reduced in the lower but not in the upper part of the body of the esophagus. These studies show that in man PGE2 exerts selective inhibitory influence on the activity of the lower part of the esophagus and lower esophageal sphincter which are composed of smooth muscle fibers.

The Effect of Endogenous Hypergastrinemia on Lower Esophageal Sphincter Pressure and Esophageal Motility

2011 ◽  
Vol 58 (112) ◽  
Author(s):  
Mustafa Yakut ◽  
Gokhan Kabacam ◽  
Mehmet Bektaş ◽  
Hulya Cetinkaya ◽  
Murat Toruner ◽  
...  
Keyword(s):  
Lower Esophageal Sphincter ◽  
Esophageal Motility ◽  
Lower Esophageal Sphincter Pressure ◽  
Sphincter Pressure ◽  
Esophageal Sphincter

PS01.056: ELECTRICAL STIMULATION OF THE LOWER ESOPHAGEAL SPHINCTER IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE AND IMPAIRED ESOPHAGEAL MOTILITY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 66-66
Author(s):  
Matthias Paireder ◽  
Ivan Kristo ◽  
Erwin Rieder ◽  
Katrin Schwameis ◽  
Johannes Steindl ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Side Effects ◽  
Lower Esophageal Sphincter ◽  
Esophageal Motility ◽  
Operating Time ◽  
Mean Difference ◽  
Time Of Surgery ◽  
Gastrointestinal Side Effects ◽  
Esophageal Sphincter ◽  
Gerd Symptoms

Abstract Background Laparoscopic fundoplication (LF) is considered as standard surgical antireflux therapy. However, even if performed in specialized centers, the procedure can be followed by long-term side effects dysphagia, gas bloating or inability to belch. Especially patients with motility disorders (IEM) and concurrent GERD are prone to postoperative dysphagia after LF. The aim of this study is the evaluation of electrical stimulation (EST) of the lower esophageal sphincter (LES) in patients with IEM and GERD and its impact on procedure-related gastrointestinal side effects such as dysphagia. Methods This is a prospective, open-label, non-randomized single-center study. All variables are depicted as median and interquartile range (IQR) or 95% confidence intervals (CIs) or mean with standard deviation (SD). Ineffective esophageal motility (IEM) was defined as a Distal Contractile Integral (DCI) below 450 mmHg-s-cm in ≥ 5 of out 10 swallows. Differences in GERD health-related quality of life (HRQL) scores before and after treatment were compared with paired t-test due to a normal distribution. P-values < 0.05 were considered significant. Results Between 05/2015 and 10/2017 twenty patients were treated with LES-stimulation for GERD. Thirteen patients (61.9%) presented with IEM in esophageal manometry before surgery and were included in this analysis. DCI was 91 (IQR 30.5–331.5) mmHg-s-cm. Median 24-hours esophageal pH at baseline was 10.2% (IQR 4.4–21.5). Fifty-seven percent of patients were treated with PPI at time of surgery. Nine patients (69.2%) presented with typical GERD symptoms whereas 6 patients (46.2%) also presented with atypical GERD symptoms. BMI was 26.1 (SD 4.9). Eight patients (61.5%) showed a hiatal hernia at the time of surgery and underwent also hiatal repair. Operating time was 59 minutes (IQR 34.5–70.25). HRQL for heartburn at baseline was 21.1 (SD 5.4) and improved to 7.3 after surgery (SD 6.7) at follow up of one month (mean difference 13.8 (CI 12.5–15.1) P < 0.001). HRQL for regurgitation at baseline was 18.69 (SD 6.9) and improved to 3.84 (SD 2.4) (mean difference 14.9 (CI 13.95–15.76) P < 0.001). No patients showed any clinical signs of dysphagia nor impaired findings in postoperative contrast swallow. Gastrointestinal side effects such as the inability to belch or bloating were not seen in any patients. There were no severe adverse events related to the procedure, but one patient need re-do surgery and re-implantation of the LES-stimulation due to a breaking of the lead close to the implanted pulse generator after one year. Conclusion LES-EST was introduced as a potential alternative technique to avoid side effects of LF. It was demonstrated that LES-EST significantly raises the LES pressure and improved GERD symptoms such as heartburn and regurgitation. The advantage of this procedure is that the anatomy of the esophageal-gastric junction is not altered dramatically. Disclosure All authors have declared no conflicts of interest.

The Impact of Bariatric Procedures on Esophageal Motility

2021 ◽  
Vol 1 (3) ◽  
pp. 268-276
Author(s):  
Fernando A. M. Herbella ◽  
Marco G. Patti
Keyword(s):  
Bariatric Surgery ◽  
Sleeve Gastrectomy ◽  
Lower Esophageal Sphincter ◽  
Esophageal Motility ◽  
Adjustable Gastric Banding ◽  
Different Types ◽  
Resting Pressure ◽  
Esophageal Sphincter ◽  
The Impact ◽  
The Relationship

Bariatric operations may cause or cure gastroesophageal reflux disease (GERD). The comprehension of esophageal motility following different types of bariatric procedures may help understand the relationship between GERD and bariatric surgery. This review focused on the impact of bariatric procedures on esophageal motility. We found that lower esophageal sphincter resting pressure is increased after adjustable gastric banding; is unaltered or decreased after Roux-en-Y gastric bypass; and is decreased after sleeve gastrectomy. Lower esophageal sphincter relaxation may be abnormal after all these procedures. Esophageal body contractility is worsened after sleeve gastrectomy.

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