Su1160 Pharmacologic Challenge With Amyl Nitrite Distinguishes Between Structural Esophagogastric Junction and Functional Lower Esophageal Sphincter Abnormalities Causing Esophageal Outflow Obstruction in the Post-Operative Setting

2016 ◽  
Vol 150 (4) ◽  
pp. S1207-S1208
Author(s):  
Arash Babaei ◽  
Jon Gould ◽  
Syed I. Rahman ◽  
Reza Shaker ◽  
Benson T. Massey
Keyword(s):  
Lower Esophageal Sphincter ◽  
Esophagogastric Junction ◽  
Outflow Obstruction ◽  
Amyl Nitrite ◽  
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.

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

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.

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.

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