Detection of transient lower esophageal sphincter relaxations (TLESRs) by transmucosal potential difference (TMPD) recording at the esophagogastric junction (EGJ)

2003 ◽  
Vol 124 (4) ◽  
pp. A410
Author(s):  
Stefania Camagnola ◽  
Jac Oors ◽  
Andre J.P. Smout
Keyword(s):  
Lower Esophageal Sphincter ◽  
Esophagogastric Junction ◽  
Potential Difference ◽  
Esophageal Sphincter

scholarly journals Physiological and pathological roles of the accommodation response in lower esophageal sphincter relaxation during wet swallows

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kazumasa Muta ◽  
Eikichi Ihara ◽  
Shohei Hamada ◽  
Hiroko Ikeda ◽  
Masafumi Wada ◽  
...  
Keyword(s):  
Clinical Practice ◽  
High Resolution ◽  
Observational Study ◽  
Lower Esophageal Sphincter ◽  
Relaxation Function ◽  
Esophagogastric Junction ◽  
Prospective Observational Study ◽  
Outflow Obstruction ◽  
High Resolution Manometry ◽  
Esophageal Sphincter

AbstractThe preparatory accommodation response of lower esophageal sphincter (LES) before swallowing is one of the mechanisms involved in LES relaxation during wet swallows, however, the physiological and/or pathological roles of LES accommodation remain to be determined in humans. To address this problem, we conducted a prospective observational study of 38 patients with normal high-resolution manometry (HRM) and 23 patients with idiopathic esophagogastric junction outflow obstruction (EGJOO) to assess dry and wet swallows. The LES accommodation measurement was proposed for practical use in evaluating the LES accommodation response. Although swallow-induced LES relaxation was observed in both dry and wet swallows, LES accommodation (6.4, 3.1–11.1 mmHg) was only observed in wet swallows. The extent of LES accommodation was impaired in idiopathic EGJOO (0.6, − 0.6–6 mmHg), and the LES accommodation measurement of patients with idiopathic EGJOO (36.8, 29.5–44.3 mmHg) was significantly higher in comparison to those with normal HRM (23.8, 18–28.6 mmHg). Successful LES relaxation in wet swallowing can be achieved by LES accommodation in combination with swallow-induced LES relaxation. Impaired LES accommodation is characteristic of idiopathic EGJOO. In addition to the IRP value, the LES accommodation measurement may be useful for evaluating the LES relaxation function in clinical practice.

Human lower esophageal sphincter pressure response to increased intra-abdominal pressure

1990 ◽  
Vol 258 (4) ◽  
pp. G624-G630 ◽  
Author(s):  
R. K. Mittal ◽  
M. Fisher ◽  
R. W. McCallum ◽  
D. F. Rochester ◽  
J. Dent ◽  
...  
Keyword(s):  
Lower Esophageal Sphincter ◽  
Esophagogastric Junction ◽  
Tonic Contraction ◽  
Pressure Response ◽  
Abdominal Pressure ◽  
Abdominal Compression ◽  
Gastric Pressure ◽  
Straight Leg Raising ◽  
Esophageal Sphincter ◽  
Crural Diaphragm

We studied the effects of increased intra-abdominal pressure on the lower esophageal sphincter (LES) pressure in 15 healthy subjects. The role of the diaphragm in the genesis of LES pressure during increased intra-abdominal pressure was determined by measuring diaphragm electromyogram (EMG). The latter was recorded using bipolar intraesophageal platinum electrodes that were placed on the nonpressure sensing surface of the sleeve device. We also measured the LES pressure response to increased intra-abdominal pressure during inhibition of the smooth muscles of the LES by intravenous atropine (12 micrograms/kg). Straight-leg raising and abdominal compression were used to increase intra-abdominal pressure. Our results show that the increase in LES pressure during straight-leg raising is greater than the increase in gastric pressure. During abdominal compression, the rate of LES pressure increase is faster than that of the gastric pressure, suggesting an active contraction at the esophagogastric junction. The increase in LES pressure during periods of increased intra-abdominal pressure is associated with a tonic contraction of the crural diaphragm as demonstrated by EMG recording. Atropine inhibited the resting LES pressure by 50-70% in each subject but had no effect either on the peak LES pressure attained during increased intra-abdominal pressure or tonic crural diaphragm EMG. We conclude that 1) there is an active contraction at the esophagogastric junction during periods of increased intra-abdominal pressure and 2) tonic contraction of the crural diaphragm is a mechanism for this LES pressure response.

Su1096 Mechanisms of Acotiamide-Sensitive Impaired Lower Esophageal Sphincter Accommodation in Patients With Esophagogastric Junction Outflow Obstruction

2016 ◽  
Vol 150 (4) ◽  
pp. S468
Author(s):  
Kazumasa Muta ◽  
Eikichi Ihara ◽  
Keita Fukaura ◽  
Xiaopeng Bai ◽  
Yoshimasa Tanaka ◽  
...  
Keyword(s):  
Lower Esophageal Sphincter ◽  
Esophagogastric Junction ◽  
Outflow Obstruction ◽  
Esophageal Sphincter

scholarly journals Esophagogastric junction distensibility: a factor contributing to sphincter incompetence

2002 ◽  
Vol 282 (6) ◽  
pp. G1052-G1058 ◽  
Author(s):  
John E. Pandolfino ◽  
Guoxiang Shi ◽  
Jennifer Curry ◽  
Raymond J. Joehl ◽  
James G. Brasseur ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Lower Esophageal Sphincter ◽  
Hiatus Hernia ◽  
Reflux Disease ◽  
Esophagogastric Junction ◽  
Normal Subjects ◽  
Opening Pressure ◽  
Esophageal Sphincter

To quantify the effect of hiatus hernia (HH) on esophagogastric junction (EGJ) distensibility, eight normal subjects and nine gastroesophageal reflux disease (GERD) patients with HH were studied with concurrent manometry, fluoroscopy, and stepwise controlled barostatic distention of the EGJ. The minimal barostatic pressure required to open the EGJ during the interswallow period was determined. Thereafter, barium swallows were imaged in 5-mmHg increments of intrabag pressure. EGJ diameter and length were measured at each pressure during deglutitive relaxation. The EGJ opening diameter was greater in hernia patients compared with normal subjects during deglutitive relaxation at all pressures, and EGJ length was 23% shorter. EGJ opening pressure among hernia patients was lower than normal subjects during the interswallow period. In conclusion, the EGJ of GERD patients with HH was more distensible and shorter than normal subjects. These findings partially explain why HH patients are predisposed to reflux by mechanisms other than transient lower esophageal sphincter relaxations, sustain greater volumes of refluxate, and have a reduced ability to discriminate gas from liquid reflux.

Sphincteric action of the diaphragm during a relaxed lower esophageal sphincter in humans

1989 ◽  
Vol 256 (1) ◽  
pp. G139-G144 ◽  
Author(s):  
R. K. Mittal ◽  
D. F. Rochester ◽  
R. W. McCallum
Keyword(s):  
Lower Esophageal Sphincter ◽  
Esophagogastric Junction ◽  
Voluntary Contraction ◽  
Pressure Increase ◽  
Healthy Human ◽  
Bipolar Electrodes ◽  
Human Volunteers ◽  
Esophageal Sphincter ◽  
Crural Diaphragm ◽  
Voluntary Contractions

We studied the effects of involuntary and voluntary contraction of the diaphragm on esophagogastric junction (EGJ) pressure during esophageal distension in healthy human volunteers. The EGJ pressure was monitored using a Dent sleeve device. Along with the pressure we concurrently monitored diaphragm electromyogram (EMG) using intra-esophageal bipolar electrodes that were placed on the nonpressure sensing surface of the sleeve device. Graded esophageal distensions were performed by graded inflations of a 2-cm-diameter balloon that was positioned 7 cm above the EGJ. The graded esophageal distensions caused a graded increase in the amplitude of lower esophageal sphincter (LES) relaxation (end-expiratory EGJ pressure). In a majority of the subjects, esophageal distension had no effect on spontaneous inspiratory EGJ pressure increase and diaphragm EMG. During sustained LES relaxation of greater than 70% induced by sustained esophageal distention, graded voluntary contractions of the diaphragm induced proportional increases in the EGJ pressure and diaphragm EMG. The EGJ pressure and diaphragm EMG were similar during diaphragmatic contraction both before and during esophageal distension. During a maximal and sustained diaphragm contraction, esophageal distension had no effect on the EGJ pressure. We conclude that there are two distinct sphincteric mechanisms at the EGJ, the LES and crural diaphragm, and they respond differently to distension of the distal esophagus.

Distension of the esophagogastric junction augments triggering of transient lower esophageal sphincter relaxation

2011 ◽  
Vol 301 (4) ◽  
pp. G713-G718 ◽  
Author(s):  
Michiel P. van Wijk ◽  
L. Ashley Blackshaw ◽  
John Dent ◽  
Marc A. Benninga ◽  
Geoffrey P. Davidson ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Lower Esophageal Sphincter ◽  
Healthy Subjects ◽  
Esophagogastric Junction ◽  
Vagal Afferents ◽  
Gastric Distension ◽  
Adaptation Period ◽  
Baseline Recording ◽  
Exact Position ◽  
Esophageal Sphincter

Patients with gastroesophageal reflux disease show an increase in esophagogastric junction (EGJ) distensibility and in frequency of transient lower esophageal sphincter relaxations (TLESR) induced by gastric distension. The objective was to study the effect of localized EGJ distension on triggering of TLESR in healthy volunteers. An esophageal manometric catheter incorporating an 8-cm internal balloon adjacent to a sleeve sensor was developed to enable continuous recording of EGJ pressure during distension of the EGJ. Inflation of the balloon doubled the cross-section of the trans-sphincteric portion of the catheter from 5 mm OD (round) to 5 × 11 mm (oval). Ten healthy subjects were included. After catheter placement and a 30-min adaptation period, the EGJ was randomly distended or not, followed by a 45-min baseline recording. Subjects consumed a refluxogenic meal, and recordings were made for 3 h postprandially. A repeat study was performed on another day with EGJ distension status reversed. Additionally, in one subject MRI was performed to establish the exact position of the balloon in the inflated state. The number of TLESR increased during periods of EGJ distension with the effect being greater after a meal [baseline: 2.0(0.0–4.0) vs. 4.0(1.0–11.0), P=0.04; postprandial: 15.5(10.0–33.0) vs. 22.0(17.0–58.0), P=0.007 for undistended and distended, respectively]. EGJ distension augments meal-induced triggering of TLESR in healthy volunteers. Our data suggest the existence of a population of vagal afferents located at sites in/around the EGJ that may influence triggering of TLESR.

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