scholarly journals Atypical Manometric Abnormality of the Lower Esophageal Sphincter: A Procedure-Related, Stress-Induced Phenomenon?

1995 ◽  
Vol 9 (6) ◽  
pp. 349-351 ◽  
Author(s):  
Bhuvanendram Indrakrishnan ◽  
William G Paterson
Keyword(s):  
Lower Esophageal Sphincter ◽  
Initial Study ◽  
Esophageal Sphincter ◽  
Related Stress ◽  
And Function ◽  
Esophageal Contraction

Stress-induced esophageal contraction abnormalities have been well documented in the literature, but relatively little is known about stress-related lower esophageal sphincter (LES) dysfunction. Two patients are described in whom initial manometry studies revealed LES hypertension and impaired LES relaxation. Both patients were markedly anxious and agitated during the initial study. However, when the manometry was repeated with the patients in a calmer state, LES pressure and function were normal. These cases demonstrate the need to be aware of stress-related LES dysfunction. If this phenomenon is not identified in the appropriate settings, it could lead to significant errors in management.

scholarly journals Circular and longitudinal muscles shortening indicates sliding patterns during peristalsis and transient lower esophageal sphincter relaxation

2015 ◽  
Vol 309 (5) ◽  
pp. G360-G367 ◽  
Author(s):  
Nirali Patel ◽  
Yanfen Jiang ◽  
Ravinder K. Mittal ◽  
Tae Ho Kim ◽  
Melissa Ledgerwood ◽  
...  
Keyword(s):  
Lower Esophageal Sphincter ◽  
Animal Studies ◽  
Longitudinal Muscle ◽  
Circular Muscle ◽  
Esophageal Sphincter ◽  
And Function ◽  
Longitudinal Muscles ◽  
Histology And Immunohistochemistry ◽  
Esophageal Contraction ◽  
Axial Shortening

Esophageal axial shortening is caused by longitudinal muscle (LM) contraction, but circular muscle (CM) may also contribute to axial shortening because of its spiral morphology. The goal of our study was to show patterns of contraction of CM and LM layers during peristalsis and transient lower esophageal sphincter (LES) relaxation (TLESR). In rats, esophageal and LES morphology was assessed by histology and immunohistochemistry, and function with the use of piezo-electric crystals and manometry. Electrical stimulation of the vagus nerve was used to induce esophageal contractions. In 18 healthy subjects, manometry and high frequency intraluminal ultrasound imaging during swallow-induced esophageal contractions and TLESR were evaluated. CM and LM thicknesses were measured (40 swallows and 30 TLESRs) as markers of axial shortening, before and at peak contraction, as well as during TLESRs. Animal studies revealed muscular connections between the LM and CM layers of the LES but not in the esophagus. During vagal stimulated esophageal contraction there was relative movement between the LM and CM. Human studies show that LM-to-CM (LM/CM) thickness ratio at baseline was 1. At the peak of swallow-induced contraction LM/CM ratio decreased significantly (<1), whereas the reverse was the case during TLESR (>2). The pattern of contraction of CM and LM suggests sliding of the two muscles. Furthermore, the sliding patterns are in the opposite direction during peristalsis and TLESR.

Trans-Oral Incisionless Fundoplication (TIF): How I Do It and Why

2021 ◽  
pp. 263451612110249
Author(s):  
Kenneth J. Chang
Keyword(s):  
Hernia Repair ◽  
Lower Esophageal Sphincter ◽  
Treatment Option ◽  
Structure And Function ◽  
Transoral Incisionless Fundoplication ◽  
Standardized Protocol ◽  
Esophageal Sphincter ◽  
And Function ◽  
Flap Valve

Transoral Incisionless Fundoplication (TIF) is designed to create a 3 cm length, 270° to 300°, omega-shaped flap valve, reconstructing the structure and function of the lower esophageal sphincter (LES), including the gastric sling fibers. As such, TIF is a treatment option for GERD patients with an intact crura, but have lost the integrity and function of the LES. In patients requiring a hernia repair, TIF can be used concomitantly (cTIF). While there are a number of steps to the TIF 2.0 procedure, many of the sequences are repetitive and follow a standardized protocol, optimizing efficiency, safety, and scalability.

Inhibition of transient lower esophageal sphincter relaxations by electrical acupoint stimulation

2005 ◽  
Vol 289 (2) ◽  
pp. G197-G201 ◽  
Author(s):  
Duowu Zou ◽  
Wei Hao Chen ◽  
Katsuhiko Iwakiri ◽  
Rachael Rigda ◽  
Marcus Tippett ◽  
...  
Keyword(s):  
Healthy Volunteers ◽  
Lower Esophageal Sphincter ◽  
Gastrointestinal Symptoms ◽  
Endogenous Opioids ◽  
Gastric Distension ◽  
Gastric Distention ◽  
Upper Gastrointestinal Symptoms ◽  
Esophageal Sphincter ◽  
And Function ◽  
Acupoint Stimulation

Acupuncture has been shown to modulate visceral sensation and function. Traditionally, stimulation at the Neiguan (pericardial meridian) has been used to treat upper gastrointestinal symptoms. Some of the effects of acupuncture may be mediated through release of endogenous opioids and are reversed by naloxone. Gastric distension is the major trigger for transient lower esophageal sphincter (LES) relaxations (TLESRs). The aim of this study was to investigate the effect of electric stimulation at the Neiguan and naloxone on the TLESRs. In 14 healthy volunteers, electrical acupoint stimulation was applied at the Neiguan and a sham point on the hip in randomized order on the same day. In 12 healthy volunteers, the effects of naloxone (80 μg/kg iv bolus injection) and saline on electrical acupoint stimulation were compared on separate days at least 1 wk apart. Esophageal motility was measured during distension of the proximal stomach with 500 ml of air using a barostat balloon. Electric acupoint stimulation at the Neiguan decreased the rate of TLESRs by ∼40% from a median of 6/h to 3.5/h ( P < 0.02). Acupoint stimulation had no effect on basal LES pressure, the residual LES pressure during TLESRs, the duration of TLESRs, or gastrointestinal symptoms of fullness, bloating, discomfort, or nausea. The effect of acupoint stimulation was not inhibited by naloxone. Electric acupoint stimulation at the Neiguan significantly inhibits the frequency of TLESRs in response to gastric distention in healthy subjects. This effect does not appear to be mediated through μ-opioid receptors.

Characteristics of transient lower esophageal sphincter relaxation in humans

1987 ◽  
Vol 252 (5) ◽  
pp. G636-G641 ◽  
Author(s):  
R. K. Mittal ◽  
R. W. McCallum
Keyword(s):  
Electrical Activity ◽  
Lower Esophageal Sphincter ◽  
Healthy Subjects ◽  
Acid Reflux ◽  
Equal Frequency ◽  
Mylohyoid Muscle ◽  
Postprandial State ◽  
Lower Esophageal Sphincter Relaxation ◽  
Esophageal Sphincter ◽  
Esophageal Contraction

Transient lower esophageal sphincter relaxations (TLESR) were studied in 10 normal healthy subjects. Electrical activity of mylohyoid muscle measured by an electromyogram (MEMG), pressures from pharynx, three esophageal sites, lower esophageal sphincter, and stomach were simultaneously recorded for 1 h, while fasting and 3 h after an 850 kcal meal. Reflux of acid into esophagus and/or occurrence of belching accompanying a TLESR was also monitored. TLESRs occurred with an equal frequency in fasting and postprandial state (6.2 vs. 6.4 h). However, frequency of an acid reflux during a TLESR was much greater postprandially than after fasting (44.8 vs. 9.6%). Belching coincided with 8% of TLESRs. A small MEMG complex and a small pharyngeal complex were present at onset of TLESR in 41.6 and 26.9% of instances, respectively. TLESRs were then categorized as either postswallow, if it occurred within 10 s of a preceding swallow-induced LES relaxation, or isolated, if its onset to previous swallow was greater than 10 s. Esophageal contractions were noticed at onset of 84% of isolated TLESRs. When present at two distal sites, this contraction was always of a simultaneous nature. Esophageal contractions at onset of postswallow TLESR were less frequent (33.3%) but when present were usually observed at the proximal esophageal site. At completion of a TLESR, the LES never recovered without an associated esophageal contraction, the latter was either swallow mediated or a spontaneous simultaneous esophageal contraction. Our data indicate that 1) MEMG and pharyngeal motor events may accompany TLESRs; and 2) esophageal contraction frequently heralds the onset, and it always occurs at completion of a TLESR.(ABSTRACT TRUNCATED AT 250 WORDS)

Impaired platelet-derived growth factor receptor expression and function in cultured lower esophageal sphincter circular smooth muscle cells from W/Wv mutant mice

2014 ◽  
Vol 92 (1) ◽  
pp. 34-41 ◽  
Author(s):  
Francisco Bautista-Cruz ◽  
Dileep G. Nair ◽  
Sandra Lourenssen ◽  
David V. Miller ◽  
Michael G. Blennerhassett ◽  
...  
Keyword(s):  
Smooth Muscle ◽  
Growth Factor ◽  
Lower Esophageal Sphincter ◽  
Mutant Mice ◽  
Platelet Derived Growth Factor ◽  
Wild Type ◽  
Rt Pcr ◽  
Circular Smooth Muscle ◽  
Esophageal Sphincter ◽  
And Function

We have previously demonstrated that lower esophageal sphincter (LES) circular smooth muscle (CSM) is functionally impaired in W/Wv mutant mice that lack interstitial cells of Cajal, and speculated that this could be due to altered smooth muscle differentiation. Platelet-derived growth factor (PDGF) is involved in the maturation and differentiation of smooth muscle. To determine whether PDGF expression and (or) function is altered in W/Wv mutant mice, PDGF-Rβ expression was measured using RT-PCR, qPCR, and immunocytochemistry, and Ca2+ imaging and perforated patch clamp recordings performed in isolated LES CSM cells. RT-PCR and immunocytochemistry showed significantly reduced PDGF-Rβ expression in the LES from mutant as opposed to wild-type mice. Quantitative comparison of CSM cell numbers in histological specimens revealed a significantly increased average cell size in the mutant tissue. The specific PDGF-Rβ ligand, PDGF-BB, caused a significant increase in intracellular Ca2+ in cells from the wild-type mice compared with the mutants. Using a ramp protocol, PDGF-BB caused a 2-fold increase in outward K+ currents in cells from the wild-type mice, whereas no significant increase was measured in the cells from the mutants. We conclude that the expression and function of PDGF-Rβ in LES CSM from W/Wv mice is impaired, providing further evidence that LES CSM is abnormal in W/Wv mutants.

scholarly journals Esophageal wall blood perfusion during contraction and transient lower esophageal sphincter relaxation in humans

2012 ◽  
Vol 303 (5) ◽  
pp. G529-G535 ◽  
Author(s):  
Yanfen Jiang ◽  
Valmik Bhargava ◽  
Young Sun Kim ◽  
Ravinder K. Mittal
Keyword(s):  
Lower Esophageal Sphincter ◽  
Longitudinal Muscle ◽  
Blood Perfusion ◽  
Laser Doppler ◽  
Esophageal Wall ◽  
Esophageal Mucosa ◽  
Doppler Probe ◽  
Innovative Technique ◽  
Esophageal Sphincter ◽  
Esophageal Contraction

We recently reported that esophageal contraction reduces esophageal wall perfusion in an animal study. Our aim was to determine esophageal wall blood perfusion (EWBP) during esophageal contraction and transient lower esophageal sphincter relaxations (TLESRs) in humans. We studied 12 healthy volunteers. A custom-designed laser Doppler probe was anchored to the esophageal wall, 4–6 cm above the LES, by use of the Bravo pH system so that the laser light beam stay directed toward the esophageal mucosa. A high-resolution manometry equipped with impedance electrodes recorded esophageal pressures and reflux events. Synchronized pressure, impedance, pH, and EWBP recordings were obtained during dry and wet swallows and following a meal. Stable recordings of laser Doppler EWBP were only recorded when the laser Doppler probe was firmly anchored to the esophageal wall. Esophageal contractions induced by dry and wet swallows resulted in 46 ± 9% and 60 ± 10% reduction in the EWBP, respectively (compared to baseline). Reduction in EWBP was directly related to the amplitude (curvilinear fit) and duration of esophageal contraction. Atropine reduced the esophageal contraction amplitude and decreased the EWBP reduction associated with esophageal contraction. TLESRs were also associated with reduction in the EWBP, albeit of smaller amplitude (29 ± 3%) but longer duration (19 ± 2 s) compared with swallow-induced esophageal contractions. We report 1) an innovative technique to record EWBP for extended time periods in humans and 2) contraction of circular and longitudinal muscle during peristalsis and selective longitudinal muscle contraction during TLESR causes reduction in the EWBP; 3) using our innovative technique, future studies may determine whether esophageal wall ischemia is the cause of esophageal pain/heartburn.

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