479 Esophageal Contraction & Transient Lower Esophageal Sphincter Relaxations are Associated With Reduction in Esophageal Wall Blood Perfusion in Humans

2012 ◽  
Vol 142 (5) ◽  
pp. S-101-S-102
Author(s):  
Yanfen Jiang ◽  
Young Sun Kim ◽  
Valmik Bhargava ◽  
Ravinder K. Mittalr
Keyword(s):  
Lower Esophageal Sphincter ◽  
Blood Perfusion ◽  
Esophageal Wall ◽  
Esophageal Sphincter ◽  
Esophageal Contraction

scholarly journals Esophageal wall blood perfusion during contraction and transient lower esophageal sphincter relaxation in humans

2012 ◽  
Vol 303 (5) ◽  
pp. G529-G535 ◽  
Author(s):  
Yanfen Jiang ◽  
Valmik Bhargava ◽  
Young Sun Kim ◽  
Ravinder K. Mittal
Keyword(s):  
Lower Esophageal Sphincter ◽  
Longitudinal Muscle ◽  
Blood Perfusion ◽  
Laser Doppler ◽  
Esophageal Wall ◽  
Esophageal Mucosa ◽  
Doppler Probe ◽  
Innovative Technique ◽  
Esophageal Sphincter ◽  
Esophageal Contraction

We recently reported that esophageal contraction reduces esophageal wall perfusion in an animal study. Our aim was to determine esophageal wall blood perfusion (EWBP) during esophageal contraction and transient lower esophageal sphincter relaxations (TLESRs) in humans. We studied 12 healthy volunteers. A custom-designed laser Doppler probe was anchored to the esophageal wall, 4–6 cm above the LES, by use of the Bravo pH system so that the laser light beam stay directed toward the esophageal mucosa. A high-resolution manometry equipped with impedance electrodes recorded esophageal pressures and reflux events. Synchronized pressure, impedance, pH, and EWBP recordings were obtained during dry and wet swallows and following a meal. Stable recordings of laser Doppler EWBP were only recorded when the laser Doppler probe was firmly anchored to the esophageal wall. Esophageal contractions induced by dry and wet swallows resulted in 46 ± 9% and 60 ± 10% reduction in the EWBP, respectively (compared to baseline). Reduction in EWBP was directly related to the amplitude (curvilinear fit) and duration of esophageal contraction. Atropine reduced the esophageal contraction amplitude and decreased the EWBP reduction associated with esophageal contraction. TLESRs were also associated with reduction in the EWBP, albeit of smaller amplitude (29 ± 3%) but longer duration (19 ± 2 s) compared with swallow-induced esophageal contractions. We report 1) an innovative technique to record EWBP for extended time periods in humans and 2) contraction of circular and longitudinal muscle during peristalsis and selective longitudinal muscle contraction during TLESR causes reduction in the EWBP; 3) using our innovative technique, future studies may determine whether esophageal wall ischemia is the cause of esophageal pain/heartburn.

Characteristics of transient lower esophageal sphincter relaxation in humans

1987 ◽  
Vol 252 (5) ◽  
pp. G636-G641 ◽  
Author(s):  
R. K. Mittal ◽  
R. W. McCallum
Keyword(s):  
Electrical Activity ◽  
Lower Esophageal Sphincter ◽  
Healthy Subjects ◽  
Acid Reflux ◽  
Equal Frequency ◽  
Mylohyoid Muscle ◽  
Postprandial State ◽  
Lower Esophageal Sphincter Relaxation ◽  
Esophageal Sphincter ◽  
Esophageal Contraction

Transient lower esophageal sphincter relaxations (TLESR) were studied in 10 normal healthy subjects. Electrical activity of mylohyoid muscle measured by an electromyogram (MEMG), pressures from pharynx, three esophageal sites, lower esophageal sphincter, and stomach were simultaneously recorded for 1 h, while fasting and 3 h after an 850 kcal meal. Reflux of acid into esophagus and/or occurrence of belching accompanying a TLESR was also monitored. TLESRs occurred with an equal frequency in fasting and postprandial state (6.2 vs. 6.4 h). However, frequency of an acid reflux during a TLESR was much greater postprandially than after fasting (44.8 vs. 9.6%). Belching coincided with 8% of TLESRs. A small MEMG complex and a small pharyngeal complex were present at onset of TLESR in 41.6 and 26.9% of instances, respectively. TLESRs were then categorized as either postswallow, if it occurred within 10 s of a preceding swallow-induced LES relaxation, or isolated, if its onset to previous swallow was greater than 10 s. Esophageal contractions were noticed at onset of 84% of isolated TLESRs. When present at two distal sites, this contraction was always of a simultaneous nature. Esophageal contractions at onset of postswallow TLESR were less frequent (33.3%) but when present were usually observed at the proximal esophageal site. At completion of a TLESR, the LES never recovered without an associated esophageal contraction, the latter was either swallow mediated or a spontaneous simultaneous esophageal contraction. Our data indicate that 1) MEMG and pharyngeal motor events may accompany TLESRs; and 2) esophageal contraction frequently heralds the onset, and it always occurs at completion of a TLESR.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of esophageal contraction on esophageal wall blood perfusion

2011 ◽  
Vol 301 (6) ◽  
pp. G1093-G1098 ◽  
Author(s):  
Ravinder K. Mittal ◽  
Valmik Bhargava ◽  
Harshal Lal ◽  
Yanfen Jiang
Keyword(s):  
Electrical Stimulation ◽  
Blood Perfusion ◽  
Laser Doppler ◽  
Esophageal Wall ◽  
Esophageal Mucosa ◽  
Experimental Conditions ◽  
Doppler Probe ◽  
Perfusion Studies ◽  
Esophageal Contraction ◽  
Stimulation Of

Myocardial blood flow occurs during the diastolic phase of the cardiac cycle, because myocardial contraction during the systolic phase impedes myocardial perfusion. Using laser Doppler perfusion technique, we studied the effect of esophageal contraction on the esophageal wall perfusion. Studies were conducted in rats. A laser Doppler probe was anchored to the esophageal wall, and wall perfusion was studied under various experimental conditions. Increase and decrease in the systemic blood pressure induced by different pharmacological agents was associated with the increase and decrease in the esophageal wall perfusion, respectively. Esophageal contractions induced by electrical stimulation of the vagus nerve and electrical stimulation of the muscle directly resulted in a reduction in the esophageal wall perfusion, in a dose-dependent fashion. Esophageal wall perfusion could be monitored by placing the Doppler probe on the esophageal mucosa or on the outside of the esophageal wall. Esophageal contraction impedes entry of blood into the esophageal wall. Future studies may investigate if ischemia of the esophageal wall induced by sustained esophageal contractions/esophageal spasm is the cause of esophageal pain symptoms in humans.

scholarly journals Circular and longitudinal muscles shortening indicates sliding patterns during peristalsis and transient lower esophageal sphincter relaxation

2015 ◽  
Vol 309 (5) ◽  
pp. G360-G367 ◽  
Author(s):  
Nirali Patel ◽  
Yanfen Jiang ◽  
Ravinder K. Mittal ◽  
Tae Ho Kim ◽  
Melissa Ledgerwood ◽  
...  
Keyword(s):  
Lower Esophageal Sphincter ◽  
Animal Studies ◽  
Longitudinal Muscle ◽  
Circular Muscle ◽  
Esophageal Sphincter ◽  
And Function ◽  
Longitudinal Muscles ◽  
Histology And Immunohistochemistry ◽  
Esophageal Contraction ◽  
Axial Shortening

Esophageal axial shortening is caused by longitudinal muscle (LM) contraction, but circular muscle (CM) may also contribute to axial shortening because of its spiral morphology. The goal of our study was to show patterns of contraction of CM and LM layers during peristalsis and transient lower esophageal sphincter (LES) relaxation (TLESR). In rats, esophageal and LES morphology was assessed by histology and immunohistochemistry, and function with the use of piezo-electric crystals and manometry. Electrical stimulation of the vagus nerve was used to induce esophageal contractions. In 18 healthy subjects, manometry and high frequency intraluminal ultrasound imaging during swallow-induced esophageal contractions and TLESR were evaluated. CM and LM thicknesses were measured (40 swallows and 30 TLESRs) as markers of axial shortening, before and at peak contraction, as well as during TLESRs. Animal studies revealed muscular connections between the LM and CM layers of the LES but not in the esophagus. During vagal stimulated esophageal contraction there was relative movement between the LM and CM. Human studies show that LM-to-CM (LM/CM) thickness ratio at baseline was 1. At the peak of swallow-induced contraction LM/CM ratio decreased significantly (<1), whereas the reverse was the case during TLESR (>2). The pattern of contraction of CM and LM suggests sliding of the two muscles. Furthermore, the sliding patterns are in the opposite direction during peristalsis and TLESR.

scholarly journals Atypical Manometric Abnormality of the Lower Esophageal Sphincter: A Procedure-Related, Stress-Induced Phenomenon?

1995 ◽  
Vol 9 (6) ◽  
pp. 349-351 ◽  
Author(s):  
Bhuvanendram Indrakrishnan ◽  
William G Paterson
Keyword(s):  
Lower Esophageal Sphincter ◽  
Initial Study ◽  
Esophageal Sphincter ◽  
Related Stress ◽  
And Function ◽  
Esophageal Contraction

Stress-induced esophageal contraction abnormalities have been well documented in the literature, but relatively little is known about stress-related lower esophageal sphincter (LES) dysfunction. Two patients are described in whom initial manometry studies revealed LES hypertension and impaired LES relaxation. Both patients were markedly anxious and agitated during the initial study. However, when the manometry was repeated with the patients in a calmer state, LES pressure and function were normal. These cases demonstrate the need to be aware of stress-related LES dysfunction. If this phenomenon is not identified in the appropriate settings, it could lead to significant errors in management.

Axial stretch: a novel mechanism of the lower esophageal sphincter relaxation

2007 ◽  
Vol 292 (1) ◽  
pp. G329-G334 ◽  
Author(s):  
Ibrahim Dogan ◽  
Valmik Bhargava ◽  
Jianmin Liu ◽  
Ravinder K. Mittal
Keyword(s):  
Muscle Contraction ◽  
Lower Esophageal Sphincter ◽  
Longitudinal Muscle ◽  
Mechanical Stretch ◽  
Esophageal Wall ◽  
Axial Stretch ◽  
Silicon Tube ◽  
Nitric Oxide Inhibitor ◽  
Esophageal Sphincter

Swallow and esophageal distension-induced relaxations of the lower esophageal sphincter (LES) are associated with an orad movement of the LES because of a concurrent esophageal longitudinal muscle contraction. We hypothesized that the esophageal longitudinal muscle contraction induces a cranially directed mechanical stretch on the LES and therefore studied the effects of a mechanical stretch on the LES pressure. In adult opossums, a silicon tube was placed via mouth into the esophagus and laparotomy was performed. Two needles with silk sutures were passed, 90° apart, through the esophageal walls and silicon tube, 2 cm above the LES. The tube was withdrawn, and one end of each of the four sutures was anchored to the esophageal wall and the other end exited through the mouth to exert graded cranially directed stretch on the LES by using pulley and weights. A cranially directed stretch caused LES relaxation, and with the cessation of stretch there was recovery of the LES pressure. The degree an d duration of LES relaxation increased with the weight and the duration of stretch, respectively. The mean LES relaxation in all animals was 77.7 ± 4.7%. The required weight to induce maximal LES relaxation differed in animals (714 ± 348 g). NG-nitro-L-arginine, a nitric oxide inhibitor, blocked the axial stretch-induced LES relaxation almost completely (from 78 to 19%). Our data support the presence of an axial stretch-activated inhibitory mechanism in the LES. The role of axial stretch in the LES relaxation induced by swallow and esophageal distension requires further investigation.

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