The Impact of Gastric Distension on the Lower Esophageal Sphincter and Its Exposure to Acid Gastric Juice

2010 ◽  
Vol 252 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Shahin Ayazi ◽  
Anand Tamhankar ◽  
Steven R. DeMeester ◽  
Joerg Zehetner ◽  
Calvin Wu ◽  
...  
Keyword(s):  
Gastric Juice ◽  
Lower Esophageal Sphincter ◽  
Gastric Distension ◽  
Esophageal Sphincter ◽  
The Impact

Effect of hyperglycemia on triggering of transient lower esophageal sphincter relaxations

2004 ◽  
Vol 286 (5) ◽  
pp. G797-G803 ◽  
Author(s):  
Qing Zhang ◽  
Michael Horowitz ◽  
Rachael Rigda ◽  
Christopher Rayner ◽  
Andrew Worynski ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Lower Esophageal Sphincter ◽  
Blood Glucose Concentration ◽  
Gastric Wall ◽  
Gastric Distension ◽  
Healthy Human ◽  
Patients With Diabetes ◽  
Esophageal Sphincter ◽  
Volume Controlled ◽  
Pressure Controlled

Acute changes in blood glucose concentration have major effects on gastrointestinal motor function. Patients with diabetes mellitus have an increased prevalence of gastroesophageal reflux. Transient lower esophageal sphincter (LES) relaxation (TLESR) is the most common sphincter mechanism underlying reflux. The aim of this study was to investigate the effect of acute hyperglycemia on triggering TLESRs evoked by gastric distension in healthy volunteers. TLESRs were stimulated by pressure-controlled and volume-controlled (500 ml) gastric distension using an electronic barostat and performed on separate days. On each day, esophageal manometry was performed in the sitting position during gastric distension for 1 h under euglycemia (5 mM), and either marked hyperglycemia (15 mM) or physiological hyperglycemia (8 mM) in randomized order was maintained by a glucose clamp. Marked hyperglycemia doubled the rate of TLESRs in response to both pressure-controlled [5 (3–10.5, median or interquartile range) to 10 (9.5–14.5) per hour, P < 0.02] and volume-controlled [4 (2.5–7.5) to 10.5 (7–12.5) per hour, P < 0.02] gastric distension but had no effect on basal LES pressure. Physiological hyperglycemia had no effect on the triggering of TLESRs or basal LES pressure. In healthy human subjects, marked hyperglycemia increases the rate of TLESRs. Increase in the rate of TLESRs is independent of proximal gastric wall tension. Mechanisms underlying the effect remain to be determined. Hyperglycemia may be an important factor contributing to the increased esophageal acid exposure in patients with diabetes mellitus.

Diaphragmatic contribution to gastroesophageal competence and reflux in dogs

1992 ◽  
Vol 263 (4) ◽  
pp. G551-G557 ◽  
Author(s):  
C. J. Martin ◽  
W. J. Dodds ◽  
H. H. Liem ◽  
R. O. Dantas ◽  
R. D. layman ◽  
...  
Keyword(s):  
Gastroesophageal Reflux ◽  
Lower Esophageal Sphincter ◽  
Short Duration ◽  
Gastroesophageal Junction ◽  
Selective Inhibition ◽  
High Amplitude ◽  
Gastric Distension ◽  
Esophageal Body ◽  
Esophageal Sphincter ◽  
Crural Diaphragm

Events associated with gastroesophageal reflux have been determined by concurrent diaphragmatic and esophageal body electromyography, video radiography, and manometry in four conscious dogs. Three characteristic phenomena occurred in parallel immediately before and during gastroesophageal reflux: 1) transient lower esophageal sphincter relaxation, 2) profound (99.5%) and selective inhibition of crural diaphragmatic activity, and 3) a previously unrecognized dorsal movement of the gastroesophageal junction (mean 1.3 cm) demonstrated by implanted radiological markers. The patterns associated with spontaneous acid and gas reflux were indistinguishable from those induced by gastric distension. Costolumbar diaphragmatic activity was stable up until the instant of sphincter opening, when there was a single costolumbar contraction of short duration and high amplitude. Esophageal shortening did not occur before reflux. Reflux that occurred after atropine-induced inhibition of lower esophageal sphincter tone to < 2 mmHg was intermittent and coincided with selective crural inhibition. These studies demonstrated that selective crural inhibition is a prerequisite for gastroesophageal reflux and suggest that the crural diaphragm is an important factor for the maintenance of gastroesophageal competence.

H. pylori and transient lower esophageal sphincter relaxations induced by gastric distension in healthy humans

2001 ◽  
Vol 281 (2) ◽  
pp. G350-G356 ◽  
Author(s):  
Frank Zerbib ◽  
Valérie Bicheler ◽  
Véronique Leray ◽  
Madeleine Joubert ◽  
Stanislas Bruley des Varannes ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Lower Esophageal Sphincter ◽  
Proinflammatory Cytokine ◽  
Healthy Subjects ◽  
Gastric Distension ◽  
Healthy Humans ◽  
Biopsy Specimens ◽  
Esophageal Sphincter ◽  
H Pylori

The role of Helicobacter pylori infection in the control of lower esophageal sphincter (LES) motility, especially the occurrence of transient LES relaxations (TLESRs), was studied in eight H. pylori-positive and eight H. pylori-negative healthy subjects. During endoscopy, biopsy specimens were taken from the cardia, fundus, and antrum for determinations of H. pyloristatus, gastritis, and proinflammatory cytokine mucosal concentrations. LES motility was monitored during three different 30-min periods: baseline, gastric distension (barostat), and gastric distension with CCK infusion. Gastric distension significantly increased the TLESR rate, whereas CCK increased the rate of distension-induced TLESRs further and reduced resting LES pressure without significant differences between infected and noninfected subjects. H. pylori status did not influence resting LES pressure or gastric compliance. Cytokine mucosal concentrations were increased in infected patients, but no correlation was found with the TLESR rate, which was also independent of inflammation at the cardia, fundus, and antrum. These results suggest that H. pylori-associated inflammation does not affect the motor events involved in the pathogenesis of gastroesophageal reflux.

scholarly journals Impact of Laparoscopic Sleeve Gastrectomy on Esophageal Physiology

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Andrada-Loredana Popescu ◽  
Florentina Ioniţa-Radu ◽  
Mariana Jinga ◽  
Vasile-Daniel Balaban ◽  
Raluca-Simona Costache ◽  
...  
Keyword(s):  
Weight Loss ◽  
Sleeve Gastrectomy ◽  
High Resolution ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Lower Esophageal Sphincter ◽  
Esophageal Manometry ◽  
Morbidly Obese ◽  
Esophageal Physiology ◽  
Esophageal Sphincter ◽  
The Impact

Abstract Introduction: Laparoscopic sleeve gastrectomy (LSG) is a popular weight loss surgery technique, but the impact on esophageal physiology and esophagogastric junction is still debatable. The aim of our study was to evaluate the manometric changes of the lower esophageal sphincter (LES) after LSG in order to indicate LES manometry pre- procedure. Methods: In a prospective study we evaluated clinically, with upper gastrointestinal endoscopy, and high-resolution esophageal manometry 45 morbidly obese patients before, and 6-12 months after LSG. Results: The BMI (body mass index) decreased from 46.28±5.79 kg/m2 to 32.28±4.65 kg/m2 postoperatively (p <0.01), with a reduction of ~14 kg/m2 of BMI, 39.9 (±11.9) kg body weight and 29.9 (± 6.2)% of the TWL (Total Weight Loss index), in a median interval of 7.9 months. Gastroesophageal reflux disease (GERD) prevalence increased from 17.8% to 31.1% postoperatively, with new GERD onset in 22.2%, but mild symptomatology (the median GERDHRQL score increased from 1.56 to 2.84 points). Postoperatory reflux was associated with lower esophageal sphincter (LES) hypotonia, shortening of LES length and IIGP (increased intragastric pressure). Hiatal hernia repair rate was 17.8%, and proton pump inhibitor consumption 20%. After weight loss, the 10 cases of esophagitis discovered preoperatively cured, but 3 patients were diagnosed with de novo esophagitis. The prevalence of manometric dysmotility after LSG was 28.9%, lower than before surgery (44.4%). Conclusion: Even if GERD remains the main limitation of LSG, the high-resolution esophageal manometry has proved useful and should be implemented in morbidly obese evaluation protocol, to better select the bariatric procedure.

scholarly journals Gastric mechanosensory and lower esophageal sphincter function in rumination syndrome

1998 ◽  
Vol 275 (2) ◽  
pp. G314-G321 ◽  
Author(s):  
Miriam Thumshirn ◽  
Michael Camilleri ◽  
Russell B. Hanson ◽  
Donald E. Williams ◽  
Alfred J. Schei ◽  
...  
Keyword(s):  
Lower Esophageal Sphincter ◽  
Pain Perception ◽  
Motor Dysfunction ◽  
Gastric Distension ◽  
Gastric Accommodation ◽  
Standard Meal ◽  
Sphincter Function ◽  
Rumination Syndrome ◽  
Gastric Sensitivity ◽  
Esophageal Sphincter

Our hypothesis was that rumination syndrome is associated with gastric sensory and motor dysfunction. We studied gastric and somatic sensitivity, reflex relaxation of the lower esophageal sphincter (LES), and gastric compliance and accommodation postprandially and postglucagon. A barostatically controlled gastric bag and esophageal manometry were used to compare gastric sensorimotor functions and LES relaxation to gastric distension in 12 patients with rumination syndrome and 12 controls. During bag distensions, patients had greater nausea, bloating, and aggregate score, but not pain, compared with controls ( P < 0.05). At 4 and 8 mmHg gastric distension, LES tone reduction was greater in patients than in controls ( P < 0.05). Gastric compliance, accommodation to a standard meal, and response to glucagon were not different in patients and controls; however, 6 of 12 patients had no gastric accommodation; the latter patients had significantly greater pain perception during distension ( P < 0.05) but normal somatic sensitivity compared with healthy controls. Rumination syndrome is characterized by higher gastric sensitivity and LES relaxation during gastric distension. A subgroup of patients also had absent postprandial accommodation.

The impact of continuous positive airway pressure on the lower esophageal sphincter

2007 ◽  
Vol 292 (5) ◽  
pp. G1200-G1205 ◽  
Author(s):  
Kelly L. Shepherd ◽  
Richard H. Holloway ◽  
David R. Hillman ◽  
Peter R. Eastwood
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Lower Esophageal Sphincter ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Quiet Breathing ◽  
Relaxation Measurements ◽  
Reflex Activation ◽  
Esophageal Sphincter ◽  
Four Levels ◽  
The Impact

The lower esophageal sphincter (LES) is the primary barrier to gastroesophageal reflux. Reflux is associated with periods of LES relaxation, as occurs during swallowing. Continuous positive airway pressure (CPAP) has been shown to reduce reflux in individuals with and without sleep apnea, by an unknown mechanism. The aim of this study was to determine the effect of CPAP on swallow-induced LES relaxation. Measurements were made in 10 healthy, awake, supine individuals. Esophageal (Pes), LES (Ples), gastric (Pg), and barrier pressure to reflux (Pb = Ples − Pg) were recorded using a sleeve catheter during five swallows of 5 ml of water. This was repeated at four levels of CPAP (0, 5, 10, and 15 cmH2O). Pressures were measured during quiet breathing and during the LES relaxation associated with a swallow. Duration of LES relaxation was also recorded. During quiet breathing, CPAP significantly increased end-expiratory Pes, Ples, Pg, and Pb ( P < 0.05). The increase in Pb was due to a disproportionate increase in Ples compared with Pg ( P < 0.05). During a swallow, CPAP increased nadir Ples, Pg, and Pb and decreased the duration of LES relaxation (4.1 s with 0-cmH2O CPAP to 1.6 s on 15-cmH2O CPAP, P < 0.001). Pb increased with CPAP by virtue of a disproportionate increase in Ples compared with Pg. This may be due to either reflex activation of LES smooth muscle, or nonspecific transmission of pressure to the LES. The findings suggest CPAP may make the LES less susceptible to reflux by increasing Pb and decreasing the duration of LES relaxation.

Sign in / Sign up

Export Citation Format

Share Document