Reply to the letter “Measuring LES and UES basal pressure”

Abstract Aim This study aims to investigate the extent to which esophageal motility affects the development and progression of Barrett's mucosa in GERD patients. Background and Methods The Barret´s esophagus is becoming even more important against the background of an increasing incidence of adenocarcinoma of the esophagus1. The question as to why only a few patients with gastroesophageal reflux disease (GERD) develop a Barrett's esophagus has not been clarified. A cohort of 315 GERD patients with and without Barrett's esophagus who received High Resolution Manometry (HRM) as part of their regular diagnostics was therefore examined in this study. The evaluation of the HRM results was based on the Chicago classification version 3.02 and was compared with endoscopic and histological findings. Results Out of the 315 GERD patients, 67 had a Barrett's esophagus. The two patient groups (GERD without Barrett and GERD with Barrett) did not differ in demographic data and risk profile (hiatal hernia 71.4% vs 10.2%). In pH metry, both groups achieved a comparable DeMeester score as well as a similar fraction time (49.6 vs 44.2, 13% vs 11.7%). In both groups, approximately 40% of patients showed motility disorders. The mean basal pressure and the mean DCI also showed comparable values (21.2 vs 21.3, 1189.2 vs 1249.2). However, when comparing patients within the Barrett cohort with a long and a short segment Barrett (LSB, SSB), differences in peristalsis and pressure build-up of the distal esophagus become clear. Patients with an LSB showed a lower basal pressure of the lower esophageal sphincter (LES) and lower mean DCI (12.9 vs 25.0, 1230.0 vs 1389.3). In addition, they presented a hypotonic LES more frequently (54.6% vs 17.4%). Patients with LSB also showed motility disorders more often (54.6 vs 39.1), especially ineffective motility and fragmented peristalsis (18.2% vs 10.9%, 9.1% vs 2.2%). Conclusion The differences in motility disorders between Barrett and non-Barrett patients already described in other publications3 could not be confirmed in this study, despite the large cohort of 315 patients. However, the differences between LSB and SSB patients suggest that esophageal motility disorders can at least influence the severity of this disease.

Download Full-text

Interannual variability of glacier basal pressure from a 20 year record

Annals of Glaciology ◽

10.3189/2015aog70a019 ◽

2015 ◽

Vol 56 (70) ◽

pp. 33-44 ◽

Cited By ~ 9

Author(s):

Pierre-Marie Lefeuvre ◽

Miriam Jackson ◽

Gaute Lappegard ◽

Jon Ove Hagen

Keyword(s):

Interannual Variability ◽

Load Transfer ◽

Pearson Correlation ◽

Drainage System ◽

Stress Redistribution ◽

Basal Pressure ◽

Load Cells ◽

Glacier Ice ◽

Cavity Opening ◽

Rock Interface

AbstractBasal pressure has been recorded at the Svartisen Subglacial Laboratory, northern Norway, for 20 years, and is measured by load cells installed at the ice–rock interface under ~200m of glacier ice. Synchronous pressure variations between load cells are investigated as evidence of stress redistribution and hydrological bed connectivity. A running Pearson correlation is used to study the temporal variation in the response of several sensors. By studying the nature of this correlation as well as the correlation between sensor pairs, it is possible to investigate the evolution of the degree of synchronous response, and to some extent basal connectivity, at the glacier bed. Persistent seasonal variations associated with the melt season are observed throughout the measurement period, indicating dependence on surface hydrological forcing. Overlying this pattern, specific years with longer periods of positive and negative correlation of pressure between sensors are presented to show contrasting interannual variability in basal pressure. An anticorrelated connectivity is associated with a local increase in the rate of daily subglacial discharge, and is caused by load transfer or passive cavity opening. Stable weather appears to enhance connectivity of the sensors, which is attributed to the development of a persistent drainage system and stress redistribution.

Download Full-text

Anorectal manometry in children with chronic functional constipation

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032005000300010 ◽

2005 ◽

Vol 42 (3) ◽

pp. 178-181 ◽

Cited By ~ 5

Author(s):

Rosa Helena Monteiro Bigélli ◽

Maria Inez Machado Fernandes ◽

Yvone Avalloni de Moraes Villela de Andrade Vicente ◽

Roberto Oliveira Dantas ◽

Lívia Carvalho Galvão ◽

...

Keyword(s):

Anal Sphincter ◽

Anorectal Manometry ◽

External Anal Sphincter ◽

Standard Treatment ◽

Functional Constipation ◽

Residual Pressure ◽

Rectal Distension ◽

Normal Children ◽

Basal Pressure ◽

Before And After

BACKGROUND: The anorectal manometry is a very utilized and well recognized examination in children with chronic funcional constipation. The major manometric findings in these children are: anal hypotonia, anal hypertonia, paradoxal contraction of the external anal sphincter, decreased ability of internal anal sphincter to relax during rectal distension and alterations in rectal contractility, sensibility and compliance. AIMS: To evaluate the anal basal pressure and the relaxation reflex before and after standard treatment for a better understanding of the physiopathologic mechanisms involved in pediatric chronic functional constipation. METHODS: Anorectal manometry was performed before treatment on 20 children with chronic functional constipation aged 4 to 12 years and the results were compared to those obtained after standard treatment, with a good outcome. RESULTS: There was a reduction in anal basal pressure after treatment, but no differences were detected between the anorectal manometries performed before and after treatment in terms of amplitude and duration of relaxation, residual pressure, latency time, or descent and ascent angle. CONCLUSIONS: We conclude that the anal basal pressure decreased in children recovering from chronic functional constipation, but the standard treatment did not provide all the conditions necessary for the relaxation reflex of constipated children to return to the values described in normal children.

Download Full-text

Reconstruction of Anal Function by Transposed Gracilis Muscle with Electral Stimulation: Rabbit Model

The International Journal of Artificial Organs ◽

10.1177/039139889401700408 ◽

1994 ◽

Vol 17 (4) ◽

pp. 240-244 ◽

Cited By ~ 2

Author(s):

T. Shatari ◽

Y. Sugiyama ◽

T. Teramoto ◽

M. Kitajima ◽

H. Minamitani

Keyword(s):

White Male ◽

Rabbit Model ◽

Low Frequency ◽

Fecal Continence ◽

Gracilis Muscle ◽

Conditioning Group ◽

Tetanic Contraction ◽

Anal Function ◽

Basal Pressure ◽

Resting Pressure

For the reconstruction of anal function for fecally incontinent patients, it could be practicable to transpose the gracilis muscle around the anal canal, with electrical stimulation to maintain contraction. It is necessary to keep continuous tonus, so tetanic contraction or “summation” would be essential for fecal continence, with a stimulation which permits prolonged contraction. Transposition of the gracilis muscle around the rectum was performed in thirteen Japanese white male rabbits. The muscles of the conditioning group (n=8) were stimulated at 10 Hz for 6 weeks before the procedure. By stimulation at 15 Hz, a low frequency to permit prolonged contraction, the neoanal pressure increased maximally to 134.2 ± 55.6 cmH2O (mean ± s.d.) in the conditioning group, and to 115.0 ± 37.1 cmH2O in the non-conditionin group (n=5) (N.S.). But, the basal pressure with stimulation rose 82.3 ± 12.4% (mean ± s.d.) of the increase in the conditioning group, while that of the non-conditioning group remained at resting pressure (p<0.001). The conditioning made it possible for the rabbit's gracilis muscle to create anal pressure with a sufficient rise in the basal pressure at a frequency permitting prolonged contraction.

Download Full-text

The Effect of Propofol on the Canine Sphincter of Oddi

HPB Surgery ◽

10.1155/1994/78764 ◽

1994 ◽

Vol 7 (4) ◽

pp. 297-304 ◽

Cited By ~ 9

Author(s):

T. H. Baron ◽

C. B. Dalton ◽

P. B. Cotton ◽

G. R. May ◽

L. G. Milton ◽

...

Keyword(s):

Phase I ◽

Motor Function ◽

Sphincter Of Oddi ◽

Migrating Motor Complex ◽

Pressure Amplitude ◽

Low Doses ◽

Basal Pressure ◽

Motor Complex ◽

Single Lumen

To assess the effect of propofol on the canine sphincter of Oddi (SO), sphincter of Oddi manometry (SOM) was performed in fasting dogs which had undergone cholecystectomy and placement of modified Thomas duodenal cannulae. Using two water-perfused, single-lumen manometric catheters, SO and duodenal pressures were measured simultaneously. Baseline SO activity was recorded for at least one complete interdigestive cycle followed by bolus injections of propofol (Diprivan ®) (N = 31) from 0.1 to 4.0 mg/kg during Phase I of the Migrating Motor Complex (MMC).When propofol was administered in bolus doses ≤ 0.5 mg/kg, no change in SO or duodenal motor function was seen. In doses ≥ 0.5 mg/kg, SO basal pressure, amplitude, and frequency of contractions increased significantly. Increases in duodenal activity paralleled SO activity. Our results suggest that propofol in low doses may be useful for sedation during Sphincter of Oddi manometry in humans. Further studies of the effects of propofol on the human sphincter of Oddi are warranted.

Download Full-text

Sphincter of Oddi regulates flow by acting as a variable resistor to flow

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.1992.263.5.g683 ◽

1992 ◽

Vol 263 (5) ◽

pp. G683-G689 ◽

Cited By ~ 2

Author(s):

Y. F. Liu ◽

G. T. Saccone ◽

A. Thune ◽

R. A. Baker ◽

J. R. Harvey ◽

...

Keyword(s):

Flow Model ◽

Sphincter Of Oddi ◽

T Test ◽

Pressure Waves ◽

Variable Resistor ◽

Contraction Frequency ◽

Basal Pressure ◽

Pumping Activity ◽

Paired T Test ◽

Stimulation Of

Two models of transsphincteric flow and a model evaluating pumping activity were established in the anesthetized Australian brush-tailed possum to determine whether the sphincter of Oddi (SO) acts as a resistor or as a pump. A simple model of transsphincteric flow (inflow only) demonstrated that at physiological common bile duct (CBD) pressure, 9.5 +/- 0.3 cmH2O (n = 7), transsphincteric flow occurred between SO pressure waves (n = 10). A second more complex transsphincteric flow model was established that permitted simultaneous measurements of inflow, outflow, CBD pressure, SO basal pressure, SO contraction frequency, and amplitude. At physiological CBD pressure, inflow always equaled outflow (157.0 +/- 11.2 and 156.4 +/- 11.4 microliters/min, respectively; n = 7). The SO displayed regular contractions superimposed on a basal pressure of 1.1 +/- 0.4 mmHg. Contraction amplitude was 12.6 +/- 3.0 mmHg and the frequency was 3.6 +/- 0.4 contractions/min (n = 7). Pressure waves recorded in the CBD corresponded to the SO contractions and reflected SO activity. Transsphincteric flow occurred between SO contractions and was obstructed by these contractions. Stimulation of SO activity (basal pressure and contraction frequency) with intra-arterial injections of motilin (200 ng/kg) or erythromycin (200 micrograms/kg) abolished transsphincteric flow. Reduction in SO contraction frequency to 72.7 +/- 7.2% (P < 0.01, paired t test) after administration of Cisapride (2 mg/kg iv) increased transsphincteric flow to 147.6 +/- 12.3% (n = 7, P < 0.05, paired t test). In six possums, possible SO pumping action was evaluated. A manometer was connected to the CBD, and a second manometer was connected to the duodenum surrounding the papilla.(ABSTRACT TRUNCATED AT 250 WORDS)

Download Full-text

A blood pressure lowering effect of lesions of the caudal periaqueductal gray: relationship to basal pressure

Brain Research ◽

10.1016/0006-8993(87)90866-3 ◽

1987 ◽

Vol 423 (1-2) ◽

pp. 373-377 ◽

Cited By ~ 14

Author(s):

David G. Ward ◽

Daniel N. Darlington

Keyword(s):

Blood Pressure ◽

Periaqueductal Gray ◽

Blood Pressure Lowering ◽

Blood Pressure Lowering Effect ◽

Basal Pressure ◽

Lowering Effect ◽

Pressure Lowering

Download Full-text

Hyperglycemia affects proximal gastric motor and sensory function during small intestinal triglyceride infusion

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.1996.271.5.g814 ◽

1996 ◽

Vol 271 (5) ◽

pp. G814-G819 ◽

Cited By ~ 11

Author(s):

G. S. Hebbard ◽

M. Samsom ◽

W. M. Sun ◽

J. Dent ◽

M. Horowitz

Keyword(s):

Gastric Emptying ◽

Normal Subjects ◽

Sensory Function ◽

Gastric Distension ◽

Visceral Sensation ◽

Gastric Tone ◽

Intraduodenal Infusion ◽

Basal Pressure ◽

Normal Individuals ◽

Patients With Diabetes

Hyperglycemia slows gastric emptying in normal individuals and patients with diabetes mellitus and may affect both somatic and visceral sensation. The effects of hyperglycemia on proximal gastric motility and sensation during intraduodenal infusion of a triglyceride emulsion were evaluated using a barostat in six normal subjects during euglycemia and hyperglycemia (approximately 15 mmol/l). Isobaric distension induced greater bag volumes during hyperglycemia compared with euglycemia at 3 (452 +/- 26 vs. 343 +/- 12 ml, P< 0.05) and 4 mmHg (600 +/- 55 vs. 497 +/- 50 ml, P < 0.05) above basal pressure. During isovolumetric distension, intrabag pressure was less during hyperglycemia at 500 (2.5 +/- 0.3 vs. 3.5 +/- 0.5 mmHg above basal pressure, P < 0.05) and 600 ml (3.0 +/- 0.4 vs. 4.5 +/- 0.5 mmHg above basal pressure, P < 0.05). Perception of nausea (P < 0.05) and fullness (P < 0.05) was increased during hyperglycemia compared with euglycemia. We conclude that hyperglycemia 1) reduces proximal gastric tone during intraduodenal triglyceride infusion, an effect that may contribute to delayed gastric emptying, and 2) increases the intensity of nausea and fullness during intraduodenal triglyceride infusion and proximal gastric distension, indicative of an effect on visceral sensation.

Download Full-text