24‐hour monitoring of transient lower esophageal sphincter relaxation events by long‐term high‐resolution impedance manometry in normal volunteers: The “mirror phenomenon”

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.

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Transient Lower Esophageal Sphincter Relaxation in Morbid Obesity

Obesity Surgery ◽

10.1007/s11695-009-9809-7 ◽

2009 ◽

Vol 19 (5) ◽

pp. 595-600 ◽

Cited By ~ 33

Author(s):

J. H. Schneider ◽

M. Küper ◽

A. Königsrainer ◽

B. Brücher

Keyword(s):

Morbid Obesity ◽

Lower Esophageal Sphincter ◽

Lower Esophageal Sphincter Relaxation ◽

Esophageal Sphincter

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THE PARTICIPATION OF THE NITRERGIC PATHWAY IN INCREASED RATE OF TRANSITORY RELAXATION OF LOWER ESOPHAGEAL SPHINCTER INDUCED BY RECTAL DISTENSION IN DOGS

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032014000200006 ◽

2014 ◽

Vol 51 (2) ◽

pp. 102-106 ◽

Cited By ~ 2

Author(s):

Michel Santos PALHETA ◽

José Ronaldo Vasconcelos da GRAÇA ◽

Armênio Aguiar dos SANTOS ◽

Liziane Hermógenes LOPES ◽

Raimundo Campos PALHETA JÚNIOR ◽

...

Keyword(s):

Methylene Blue ◽

Lower Esophageal Sphincter ◽

Esophageal Motility ◽

Control Group ◽

Rectal Distension ◽

Evaluation Protocol ◽

Lower Esophageal Sphincter Relaxation ◽

Respective Control Group ◽

Esophageal Sphincter ◽

Pre Treatment

ContextThe rectal distension in dogs increases the rate of transitory lower esophageal sphincter relaxation considered the main factor causing gastroesophageal reflux.ObjectivesThe aim of this study was evaluate the participation of the nitrergic pathway in the increased transitory lower esophageal sphincter relaxation rate induced by rectal distension in anesthetized dogs.MethodsMale mongrel dogs (n = 21), weighing 10-15 kg, were fasted for 12 hours, with water ad libitum. Thereafter, they were anesthetized (ketamine 10 mg.Kg-1+ xylazine 20 mg.Kg-1), so as to carry out the esophageal motility evaluation protocol during 120 min. After a 30-minute basal period, the animals were randomly intravenous treated whith: saline solution 0.15M (1ml.Kg-1), L-NAME (3 mg.Kg-1), L-NAME (3 mg.Kg-1) + L-Arginine (200 mg.Kg-1), glibenclamide (1 mg.Kg-1) or methylene blue (3 mg.Kg-1). Forty-five min after these pre-treatments, the rectum was distended (rectal distension, 5 mL.Kg-1) or not (control) with a latex balloon, with changes in the esophageal motility recorded over 45 min. Data were analyzed using ANOVA followed by Student Newman-Keuls test.ResultsIn comparison to the respective control group, rectal distension induces an increase in transitory lower esophageal sphincter relaxation. Pre-treatment with L-NAME or methylene blue prevents (P<0.05) this phenomenon, which is reversible by L-Arginine plus L-NAME. However, pretreating with glibenclamide failed to abolish this process.ConclusionsTherefore, these experiments suggested, that rectal distension increases transitory lower esophageal sphincter relaxation in dogs via through nitrergic pathways.

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