Effect of aging on the secondary esophageal peristalsis: presbyesophagus revisited

1995 ◽  
Vol 268 (5) ◽  
pp. G772-G779 ◽  
Author(s):  
J. Ren ◽  
R. Shaker ◽  
M. Kusano ◽  
B. Podvrsan ◽  
N. Metwally ◽  
...  
Keyword(s):  
The Elderly ◽  
Air Injection ◽  
Esophageal Peristalsis ◽  
Healthy Elderly ◽  
Balloon Distension ◽  
Esophageal Sphincter ◽  
Human Esophagus ◽  
Secondary Peristalsis ◽  
Frequency Of Stimulation ◽  
Stimulation Of

In this study we determined the effect of aging on the capability of the human esophagus to generate secondary peristalsis. We studied nine healthy young (35 +/- 2 yr, 25-45 yr) and nine healthy elderly (74 +/- 3 yr, 70-83 yr) volunteers. We stimulated secondary peristalsis by intraesophageal air injection and balloon distension. All young volunteers exhibited secondary esophageal peristalsis. In four elderly volunteers, secondary peristalsis could not be elicited with injection of any of the tested air volumes. Frequency of stimulation of secondary peristalsis and lower esophageal sphincter (LES) relaxation in response to intraesophageal air distension in the elderly was significantly lower than that in the young (P < 0.01). Stimulation of secondary peristalsis by balloon distension was less consistent compared with the air injection. In conclusion, 1) in the elderly, compared with the young, secondary esophageal peristalsis is either absent or is evoked less frequently after esophageal distension, and complete LES relaxation in response to esophageal air distension is less frequent, and 2) in both young and elderly, secondary esophageal peristalsis is induced more frequently after generalized esophageal distension by air than its segmental distension by a balloon.

Comparison of primary and secondary esophageal peristalsis in humans: effect of atropine

1991 ◽  
Vol 260 (1) ◽  
pp. G52-G57 ◽  
Author(s):  
W. G. Paterson ◽  
T. T. Hynna-Liepert ◽  
M. Selucky
Keyword(s):  
Neural Pathways ◽  
Esophageal Peristalsis ◽  
Healthy Male ◽  
Double Blind ◽  
Primary Peristalsis ◽  
Lower Amplitude ◽  
Catheter System ◽  
The Subject ◽  
Esophageal Sphincter ◽  
Secondary Peristalsis

To determine whether physiological differences exist between primary (swallow-induced) and secondary (distension-induced) peristalsis in humans, 10 healthy male volunteers underwent esophageal manometry on 2 consecutive days using a perfused intraluminal catheter system that incorporated a latex balloon. Initially the catheter was positioned so that the balloon was centered 16 cm above the lower esophageal sphincter (LES), and intraluminal pressures were recorded 21, 11, 6, and 1 cm above the LES. After a series of wet swallows, dry swallows, and balloon distensions, the catheter was repositioned so that the balloon was 6 cm above the LES and pressures were recorded 1 and 11 cm above the LES. A series of balloon distensions were repeated in this position, and the subject was then given either atropine (10 micrograms/kg iv) or placebo in a double-blind randomized fashion (on consecutive days). The protocol was then repeated in reverse order. Distension-induced responses aboral to the balloon with the balloon located 16 cm above the LES were 1) of lower amplitude, 2) more often nonperistaltic, and 3) less atropine sensitive than swallow-induced contractions at comparable sites. With the balloon located distally (6 cm above LES) contractions induced at the 11-cm site (i.e., orad to the balloon) were much more atropine sensitive than contractions induced at the same site when the balloon was located proximally (i.e., 16 cm above LES). These data suggest that, contrary to previous reports, secondary peristalsis differs significantly from primary peristalsis. Furthermore, atropine differentially effects these two types of peristalsis, suggesting that the neural pathways involved are dissimilar.

Stimulation of esophageal mechanoreceptors is dependent on rate and duration of distension

1994 ◽  
Vol 267 (1) ◽  
pp. G115-G118 ◽  
Author(s):  
P. Nguyen ◽  
D. O. Castell
Keyword(s):  
Lower Esophageal Sphincter ◽  
Inflation Rate ◽  
Sensory Perception ◽  
Sensory Awareness ◽  
Balloon Distension ◽  
Esophageal Sphincter ◽  
Stimulation Of

We randomly compared rapid (170 ml/s) and slow (0.7 ml/s) rates of balloon distension in 19 volunteers (9 male, 10 female) using a latex balloon (length 3 cm) positioned 5 cm proximal to the lower esophageal sphincter. The balloon was inflated/deflated (1-s dwell; 5- to 10-s interval) with increasing 2-ml volumes during rapid inflation studies and progressively distended during slow inflation studies while subjects blindly indicated feeling, rated as follows: 0 (no sensation); 1 (aware of balloon, but no discomfort); 2 (pain or discomfort). In a second set of studies, the balloon was left inflated for 60 s at a volume 2 ml below that producing sensation 1, and time until a change in sensation was recorded. This was repeated at a volume 2 ml below that producing sensation 2. Mean volume to sensation 1 with slow inflation was 14.6 +/- 1.2 ml (SE) and with rapid inflation was 8.5 +/- 0.8 ml (P < 0.001). Mean volume to sensation 2 with slow inflation was 23.7 +/- 1.0 ml and with rapid inflation was 17.4 +/- 1.0 ml (P < 0.001). With sustained (60 s) inflation, most subjects noted increasing sensation, independent of initial inflation rate. We conclude that distal esophageal sensory perception (both awareness and discomfort) is dependent on rate of stimulation of mechanoreceptors. A sustained distension stimulus appears to recruit additional receptors and increase the level of sensory awareness.

Effect of aging and bolus variables on pharyngeal and upper esophageal sphincter motor function

1993 ◽  
Vol 264 (3) ◽  
pp. G427-G432 ◽  
Author(s):  
R. Shaker ◽  
J. Ren ◽  
B. Podvrsan ◽  
W. J. Dodds ◽  
W. J. Hogan ◽  
...  
Keyword(s):  
Pressure Wave ◽  
Wave Amplitude ◽  
Age Groups ◽  
The Elderly ◽  
Young Group ◽  
Upper Esophageal Sphincter ◽  
Healthy Elderly ◽  
Pressure Wave Amplitude ◽  
Resting Pressure ◽  
Esophageal Sphincter

Effect of aging, bolus volume, temperature, and consistency on the pharyngeal peristalsis, as well as the effect of aging on the upper esophageal sphincter (UES) resting pressure and its response to esophageal distension by air and balloon, were studied in 14 young and 12 healthy elderly volunteers. In both age groups there was no significant volume or temperature effect on amplitude, duration, or velocity of the pharyngeal peristalsis. Compared with water swallows, mashed potato swallows resulted in a significant increase in the amplitude and duration of the hypopharyngeal peristaltic pressure wave (P < 0.05). For water swallows, the amplitude and duration of the peristaltic pressure wave in the hypopharynx were significantly increased in the elderly compared with the young group (P < 0.01). UES resting pressure in the elderly measured 43 +/- 5 (SE) mmHg and was significantly less than that of the young (71 +/- 8 mmHg; P < 0.01). Magnitude of the UES pressure decrease because of esophageal distension by air, as well as magnitude of its pressure increase because of esophageal balloon distension, was similar among young and elderly. 1) Contrary to common expectations, the parameters of the pharyngeal peristaltic pressure wave do not deteriorate in the elderly in their seventh and eighth decade. 2) Compared with the young, hypopharyngeal pressure wave amplitude and duration are significantly increased in the elderly. This increase could be caused by an adaptation response to a pharyngeal outflow compromise. 3) Pharyngeal peristaltic pressure wave amplitude and duration, but not its velocity, are modulated by the bolus consistency. This modulatory mechanism is preserved in the elderly. 4) Although UES resting pressure is significantly decreased in the elderly, its pressure response to esophageal distension by air and balloon is preserved.

Absence of a deglutitive inhibition equivalent with secondary peristalsis

2005 ◽  
Vol 288 (4) ◽  
pp. G671-G676 ◽  
Author(s):  
John E. Pandolfino ◽  
Guoxiang Shi ◽  
Qing Zhang ◽  
Peter J. Kahrilas
Keyword(s):  
Smooth Muscle ◽  
Lower Esophageal Sphincter ◽  
Intrinsic Property ◽  
Air Injection ◽  
Success Rates ◽  
Primary Peristalsis ◽  
No Inhibition ◽  
Lower Esophageal Sphincter Relaxation ◽  
Esophageal Sphincter ◽  
Secondary Peristalsis

This study aimed to determine the interactions between closely paired swallow-induced primary peristalsis (PP) and air injection-induced secondary peristalsis (SP). Ten subjects (7 men, 18–42 yr) were studied using a catheter, including two sleeves (upper and lower esophageal sphincters), a midesophageal infusion port, and seven esophageal and two pharyngeal recording sites. Ten iterations of PP and SP were induced by 5-ml water swallows and 20-ml intraesophageal air injections, respectively. Thereafter, the interactions between PP and SP, separated by 1- to 12-s intervals, were studied in all four possible sequences: paired swallows, swallow preceded by air injection, air injection preceded by swallow, and paired air injections. Tracings were analyzed for lower esophageal sphincter relaxation, presence and integrity of peristalsis, and event interaction. Eight subjects with success rates of both ≥90% PP and ≥80% SP were analyzed (PP 97 ± 2%, SP 90 ± 3%). During paired PP interactions and SP followed by PP, the first sequence was inhibited by the second with intervals < 4–6 s. However, no inhibition of the first peristaltic sequence was found in either PP followed by SP trials or SP followed by air injection. In contrast to swallowing or proximal esophageal distention, air injection into the lumen of the midesophagus does not inhibit an ongoing peristaltic event. Being that the elicitation of SP in the smooth muscle esophagus is intramurally mediated, this suggests that deglutitive inhibition is a centrally mediated phenomenon rather than an intrinsic property of peristalsis.

Influence of vagal cooling on esophageal function.

1977 ◽  
Vol 232 (2) ◽  
pp. E159 ◽  
Author(s):  
J P Ryan ◽  
W J Snape ◽  
S Cohen
Keyword(s):  
Esophageal Wall ◽  
Vagal Activity ◽  
Esophageal Peristalsis ◽  
Esophageal Function ◽  
Balloon Distension ◽  
Esophageal Balloon ◽  
Cervical Vagotomy ◽  
Bilateral Vagotomy ◽  
Esophageal Sphincter ◽  
Vagal Cooling

Experiments were performed on adult opossums to determine the effect of decreased vagal activity on the esophageal peristalsis and lower esophageal sphincter (LES) relaxation associated with pharyngeal stimulation (PS) and esophageal balloon distension (ED). The cervical vagi were exposed and cooled (individually and bilaterally) to 3 degrees C using Dry Ice and alcohol-chilled saline. Unilateral vagal cooling had no effect on the esophageal peristalsis or LES relaxation associated with PS or ED. Similarly, bilateral vagal cooling did not alter the peristalsis and sphincter relaxation induced by ED. Bilateral vagal cooling, on the other hand, significantly decreased the incidence of peristalsis and the sphincter relaxation associated with PS. Studies were also performed to examine the effect of unilateral and bilateral vagotomy of esophageal function. Neither right nor left cervical vagotomy affected esophageal peristalsis or LES relaxation, regardless of the model of stimulation. Bilateral vagotomy, however, diminished the esophageal response to PS but was without effect on the peristalsis and LES relaxation produced in response to ED. From the studies we condlude: 1) the vagus nerve is of primary importance in regulating the esophageal response to PS, and 2) local neuromuscular factors within the esophageal wall appear sufficient to initiate and maintain an esophageal response to distension.

scholarly journals Effects of esophageal acidification on esophageal reflexes controlling the upper esophageal sphincter

2019 ◽  
Vol 316 (1) ◽  
pp. G45-G54 ◽  
Author(s):  
Ivan M. Lang ◽  
Bidyut K. Medda ◽  
Reza Shaker
Keyword(s):  
Gastroesophageal Reflux ◽  
Upper Esophageal Sphincter ◽  
Esophageal Acid Exposure ◽  
Acid Exposure ◽  
Air Injection ◽  
Short Term ◽  
Balloon Distension ◽  
Increased Sensitivity ◽  
Esophageal Sphincter

Esophageal acid exposure can alter upper esophageal sphincter (UES) function, but the mechanism is unknown. The aim of this study was to determine the effects of esophageal acid exposure on esophago-UES relaxation (EURR) and contractile (EUCR) reflexes. Cats, decrebrate ( n = 27) or chronic ( n = 4), were implanted with electromyographic electrodes on pharynx, larynx, and esophagus. The esophagus was infused with either NaCl (0.9%) or HCl (0.1 N). The EUCR was activated by balloon distension in acute cats and slow air injection in chronic cats, and the EURR was activated by rapid air injection in both sets of cats. We found that NaCl infused for 15 or 30 min had no effect on EUCR or EURR in acute cats. HCl infused for 15, 30, or 45 min significantly ( P < 0.05) decreased the sensitivity to activate EUCR. HCl infused for 15 min significantly ( P < 0.05) increased and for 45 min significantly ( P < 0.05) decreased sensitivity to activate EURR. In chronic cats, HCl infused for 15 min/day increased sensitivity to activate EURR and decreased ( P < 0.05) sensitivity to activate EUCR after 4 days of infusion. EURR occurred spontaneously during HCl infusions on the 3rd and 4th ( P < 0.05) days of HCl infusion. We conclude that esophageal acid exposure initially sensitizes the esophagus to activation of EURR and desensitizes to activation of EUCR, but with longer exposure desensitizes to both. The alteration in sensitivity to activate EURR and EUCR caused by gastroesophageal reflux may play a role in the generation of supraesophageal reflux. NEW & NOTEWORTHY In acute studies, short-term esophageal acid exposure sensitizes esophagus to activation of esophago-upper esophageal sphincter relaxation response (EURR), whereas longer-term exposure inhibits EURR. Short- or long-term esophageal acid exposure decreases sensitivity to activation of esophago-upper esophageal sphincter contractile response (EUCR). In chronic studies, short-term esophageal acid exposure has the same effects on EURR and EUCR as occur acutely, but these effects take days to develop. Alteration in EURR and EUCR caused by gastroesophageal reflux may play a role in reflux disease.

Characterization and mechanisms of the pharyngoesophageal inhibitory reflex

1998 ◽  
Vol 275 (5) ◽  
pp. G1127-G1136 ◽  
Author(s):  
Ivan M. Lang ◽  
Bidyut K. Medda ◽  
Junlong Ren ◽  
Reza Shaker
Keyword(s):  
Mechanical Stimulation ◽  
Water Injection ◽  
Posterior Wall ◽  
Air Injection ◽  
Pharyngeal Mucosa ◽  
Primary Peristalsis ◽  
Slow Infusion ◽  
Secondary Peristalsis ◽  
Inhibitory Reflex ◽  
Stimulation Of

The objectives of this study were to identify and to characterize the pharyngoesophageal inhibitory reflex (PEIR) in an animal model. Thirty-one cats (2.4–5.0 kg) were anesthetized using α-chloralose (45 mg/kg ip), and esophageal peristalsis was recorded manometrically. Secondary peristalsis was activated by rapid air injection (8–20 ml) at midesophagus or slow infusion of water through the manometric catheters. Neither stimulus activated primary peristalsis. The PEIR was activated by rapid water injection or focal mechanical stimulation of the pharynx. Rapid air injection activated secondary peristalsis in 92% of the trials, and slow water infusion activated 1 secondary peristalsis every 3.2 min. Pharyngeal stimulation by 0.3, 0.5, 0.8, or 1.0 ml of water inhibited or blocked ongoing secondary peristalsis in 67, 82, 97, or 93% of trials, respectively. Mechanical stimulation of the posterior wall of the pharynx with 11–20 g pressure attenuated secondary peristalsis in 96% of the trials or blocked secondary peristalsis in 41% of the trials. Centripetal electrical stimulation at 30 Hz, 0.2 ms, 2 V for 4 s of the superior laryngeal (SLN) or glossopharyngeal (GPN) nerves blocked or inhibited secondary peristalsis in 100% of the trials. Bilateral transection of the GPN ( n = 8), but not the SLN ( n = 6), blocked the PEIR. Anesthetization of the pharyngeal mucosa using lidocaine (2%) blocked the PEIR ( n = 3). We concluded that 1) the PEIR exists in the cat, 2) mechanical stimulation of the pharynx more strongly activates the PEIR than water, 3) activation of either SLN or GPN afferents attenuates ongoing secondary peristalsis, 4) the receptors mediating the PEIR are located in the pharyngeal mucosa, and 5) both SLN and GPN contribute to the PEIR, but the GPN is the major afferent limb of this reflex.

Relation between electrical and mechanical activity in esophageal smooth muscle

1981 ◽  
Vol 240 (4) ◽  
pp. G305-G311 ◽  
Author(s):  
R. K. Goyal ◽  
J. S. Gidda
Keyword(s):  
Vagal Stimulation ◽  
Mechanical Activity ◽  
Electromechanical Delay ◽  
Spike Burst ◽  
Electromechanical Responses ◽  
Regional Gradient ◽  
Esophageal Sphincter ◽  
Frequency Of Stimulation ◽  
Vagal Efferents ◽  
Stimulation Of

Experiments were performed in anesthetized opossums. Electrical and mechanical activity was recorded simultaneously from the esophageal body at 5, 3, and 1 cm above the lower esophageal sphincter (LES). Esophageal responses were evoked by electrical stimulation of vagal efferents or by induced swallowing. Electrical and mechanical activity was associated in 86% and dissociated in 14% of the 1,200 responses examined. The frequency of dissociation was dependent on the site in the esophagus and the frequency of vagal efferent stimulation (P less than 0.05). The interval between the onset of electrical and mechanical events, called electromechanical delay, had a regional gradient: 5 cm above LES greater than 3 cm greater than 1 cm (P less than 0.01). This delay was also dependent on the frequency of stimulation. The amplitude of spike burst and the number of spikes in a burst closely correlated with the amplitude of contraction. These studies show that electromechanical responses and dissociations are dependent on the regional level in the esophagus and the frequency of vagal stimulation.

Cerebral potentials evoked by esophageal distension in human

1990 ◽  
Vol 259 (6) ◽  
pp. G955-G959 ◽  
Author(s):  
A. J. Smout ◽  
M. S. DeVore ◽  
D. O. Castell
Keyword(s):  
Evoked Potentials ◽  
Healthy Volunteers ◽  
Balloon Inflation ◽  
Balloon Distension ◽  
Stimulus Perception ◽  
Esophageal Balloon ◽  
Cerebral Evoked Potentials ◽  
Esophageal Sphincter ◽  
Human Esophagus

Recent studies have shown that cerebral evoked potentials (EPs) can be recorded after balloon distension of the human esophagus. The aim of this study was to evaluate the characteristics of these viscerosensory EPs and to investigate the relations between these EPs and perception of esophageal distension. Nineteen healthy volunteers (22-60 yr old) were studied. A balloon positioned 5 cm above the lower esophageal sphincter was inflated 10 times each minute. EPs recorded from four midline scalp electrodes were averaged for 50 and 100 inflation cycles. A clearly defined triphasic (negative-positive-negative) EP was recorded in all subjects and from all four recording sites when a volume leading to definite sensation and rapid balloon inflation (170 ml/s) was used. The latencies of the peaks were 231 +/- 7 (N1), 303 +/- 7 (P1), and 379 +/- 8 ms (N2). No significant correlation between stimulus perception and latency was found. The amplitude and quality of the EPs (scored by 3 blinded observers) increased significantly (P less than 0.01, ANOVA) with increasing sensation. Slow balloon inflation (30 ml/s) was significantly less effective in evoking EPs than rapid inflation (P less than 0.01). The EPs evoked by 100 inflations were not significantly clearer than those evoked by 50 inflations. It is concluded that the ability to record cerebral potentials evoked by esophageal balloon distension is related to the rate of balloon inflation and to the level of awareness of the stimulus.

Mechanisms of reflexes induced by esophageal distension

2001 ◽  
Vol 281 (5) ◽  
pp. G1246-G1263 ◽  
Author(s):  
Ivan M. Lang ◽  
Bidyut K. Medda ◽  
Reza Shaker
Keyword(s):  
Inflation Rate ◽  
Upper Esophageal Sphincter ◽  
Esophageal Peristalsis ◽  
Air Volume ◽  
Afferent Fibers ◽  
Mucosal Layer ◽  
Esophageal Sphincter ◽  
Secondary Peristalsis ◽  
Thoracic Vagotomy ◽  
Decerebrate Cats

We investigated the mechanisms of esophageal distension-induced reflexes in decerebrate cats. Slow air esophageal distension activated esophago-upper esophageal sphincter (UES) contractile reflex (EUCR) and secondary peristalsis (2P). Rapid air distension activated esophago-UES relaxation reflex (EURR), esophago-glottal closure reflex (EGCR), esophago-hyoid distraction reflex (EHDR), and esophago-esophagus contraction reflex (EECR). Longitudinal esophageal stretch did not activate these reflexes. Magnitude and timing of EUCR were related to 2P but not injected air volume. Cervical esophagus transection did not affect the threshold of any reflex. Bolus diversion prevented swallow-related esophageal peristalsis. Lidocaine or capsaicin esophageal perfusion, esophageal mucosal layer removal, or intravenous baclofen blocked or inhibited EURR, EGCR, EHDR, and EECR but not EUCR or 2P. Thoracic vagotomy blocked all reflexes. These six reflexes can be activated by esophageal distension, and they occur in two sets depending on inflation rate rather than volume. EUCR was independent of 2P, but 2P activated EUCR; therefore, EUCR may help prevent reflux during peristalsis. All esophageal peristalsis may be secondary to esophageal stimulation in the cat. EURR, EHDR, EGCR, and EECR may contribute to belching and are probably mediated by capsaicin-sensitive, rapidly adapting mucosal mechanoreceptors. GABA-B receptors also inhibit these reflexes. EUCR and 2P are probably mediated by slowly adapting muscular mechanoreceptors. All six reflexes are mediated by vagal afferent fibers.

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