Measurement of Lower Esophageal Sphincter (LES) Characteristics during Esophageal Manometry Does Not Differ with Severity of Ineffective Esophageal Motility

Background: Gastro esophageal reflux disease leads to poor quality of life to patients because of pain and discomfort. Some studies also reported that incidence of adenocarcinoma of esophagus and Barrett's esophagus among patients with reflux disease. The abnormal esophageal motility act as a major risk factors and also reported with severity and prognosis of the disease. Material & Methods: In present study 50 patients of heart burn or acid regurgitation (GERD) for at least more than 3 months were enrolled from outdoor and from ward by simple random sampling. Clearance from Institutional Ethics Committee was taken before start of study. Written informed consent was taken from each study participant. Results: 15 (30%) had non-erosive reflux disease and 35 (70%) had erosive reflux disease. Among the patients of non-erosive reflux disease, 13 (26%) had normal lower esophageal sphincter pressure and 2 (4%) had Low Lower esophageal sphincter pressure. Among the patients of erosive reflux disease, 32 (64%) had normal lower esophageal sphincter pressure and 3 (6%) had Low Lower esophageal sphincter pressure (P value >0.05). Among the patients of non-erosive reflux disease, 10 (20%) had normal esophageal motility and 5 (10%) had Ineffective esophageal motility. Among the patients of erosive reflux disease, 25 (50%) had normal esophageal motility and 10 (20%) had Ineffective esophageal motility (P value >0.05). Conclusion: Low Lower esophageal sphincter and Ineffective or abnormal esophageal motility pressure was non-significantly associated with non-erosive and erosive reflux disease. Ineffective esophageal motility and Low LES pressure was the main cause for gastro esophageal reflux disease Keywords: GERD, High Resolution Manometry, Ineffective peristalsis.

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Rheumatologic disorders in patients undergoing esophageal manometry: prevalence, symptom characteristics, and manometric findings

Diseases of the Esophagus ◽

10.1093/dote/doaa135 ◽

2021 ◽

Author(s):

Anam Qureshi ◽

Asad Jehangir ◽

Zubair Malik ◽

Henry P Parkman

Keyword(s):

Lupus Erythematosus ◽

Esophageal Motility ◽

Esophageal Manometry ◽

Upper Esophageal Sphincter ◽

Motility Disorders ◽

Ineffective Esophageal Motility ◽

Upper Gi ◽

Gi Symptoms ◽

Esophageal Sphincter ◽

Esophageal Contractility

Summary Rheumatologic disorders (RDs) can have gastrointestinal (GI) manifestations. Systemic sclerosis (SSc) patients often have upper GI symptoms from absent esophageal contractility (AC). Upper GI symptom characteristics and high-resolution esophageal manometry with impedance (HREMI) findings of other RDs have not been well studied. We aimed to: (i) determine the prevalence of RD in patients undergoing HREMI and (ii) assess the symptom characteristics and manometric findings of these patients. Patients undergoing HREMI (July 2018 to March 2020) rated their GI symptoms’ severity. Healthy volunteers (HVs) also underwent HREMI. Of the 1,003 patients, 90 (9%) had RD (mean age: 55.3 ± 1.4 years, 73.3% females), most commonly SSc (n = 27), rheumatoid arthritis (RA, n = 20), and systemic lupus erythematosus (SLE, n = 11). The most severe upper GI symptoms in patients with RD were heartburn, regurgitation, nausea, and dysphagia, with no significant differences in their severities between SSc, RA, and SLE. RD patients had higher upper esophageal sphincter (UES) pressures, lower distal contractile integral (DCI), lower bolus clearance, and more frequent hiatal hernia (HH) on HREMI (all P < 0.05) than HVs. Over half (61.1%) of patients with RD had esophageal motility disorders, most commonly AC (n = 25), ineffective esophageal motility (IEM; n = 18), and esophagogastric junction (EGJ) obstructive disorders (n = 11). Among patients undergoing HREMI, 9% had RD. Upper GI symptom severities did not distinguish different RDs. Patients with RD had higher UES pressures, weaker DCI, lower bolus clearance, and more frequent HH than HVs. Although AC and IEM were most common motility disorders, a considerable minority (12.2%) of our RD patients had EGJ obstructive disorders.

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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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Esophageal manometry in the opossum.

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.1977.233.3.e152 ◽

1977 ◽

Vol 233 (3) ◽

pp. E152

Author(s):

K Schulze ◽

W J Dodds ◽

J Christensen ◽

J D Wood

Keyword(s):

Animal Model ◽

Lower Esophageal Sphincter ◽

Esophageal Manometry ◽

Lower Esophageal Sphincter Pressure ◽

Upper Esophageal Sphincter ◽

Sphincter Pressure ◽

Coronal Section ◽

Esophageal Sphincter ◽

Human Esophagus

The opossum esophagus is commonly used as an animal model of the human esophagus. We used esophageal manometry in normal animals to provide basal data about normal esophageal motor functions in vivo in this species. At rest, separate and distinct high pressure zones can be recorded at the level of the lower esophageal sphincter, diaphragmatic hiatus, aortic arch, and upper esophageal sphincter. Each zone demonstrates a characteristic pattern of pressures in the radii of the coronal section and a characteristic response to swallowing. The hiatal and aortic zones can be mistaken for the esophageal sphincters. Pressures in the sphincters fall with swallowing. Peristalsis is not bolus-dependent and occurs with 98% of swallows. Pressures generated by peristalsis are greater in the middle of the esophagus than at the ends. Values for resting lower esophageal sphincter pressure and the characteristics of peristalsis were reproducible between different studies in the same animals.

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The effect of eating on lower esophageal sphincter electrical activity

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.90369.2008 ◽

2009 ◽

Vol 296 (4) ◽

pp. G793-G797

Author(s):

Claudia P. Sanmiguel ◽

Yuichiro Ito ◽

Masanobu Hagiike ◽

Jeffrey L. Conklin ◽

David Lalezari ◽

...

Keyword(s):

Electrical Activity ◽

Lower Esophageal Sphincter ◽

Esophageal Manometry ◽

Longitudinal Axis ◽

Implantable Device ◽

Solid Food ◽

Standard Meal ◽

Esophageal Sphincter

Electrical activity of the lower esophageal sphincter (LES) has been recorded mainly in vitro and in anesthetized animals. Swallowing produces relaxation of the LES, followed by its contraction. These changes should be associated with changes in LES electrical activity. To determine whether changes in LES electrical activity can be used to recognize the beginning of a meal, four dogs were implanted with two electrodes in the longitudinal axis of the LES. The electrodes were connected to an implantable device for recording of electrical activity. After recovery, dogs underwent two experiments: 1) combined recordings of LES electrical activity and esophageal manometry to test the effect of dry swallows, water, and solid food swallows on LES electrical activity and 2) telemetric recording of LES electrical activity during a standard meal. All amplitudes were in mV, means ± SD, ANOVA, P < 0.05. In experiment 1, an increase in the amplitude of LES electrical activity was associated with the substance being swallowed, i.e., at rest: 0.31 ± 0.06; dry swallows: 0.6 ± .0.1; water: 0.67 ± 0.12; solid food: 1.06 ± 0.17, P < 0.001. In experiment 2, there was a pronounced and characteristic increase in amplitude of LES electrical activity during feeding, 0.26 ± 0.1; during fasting, 0.99 ± 0.23; while eating, 0.31 ± 0.1 postprandial, P < 0.001. In conclusion, the beginning and duration of a meal are identified by distinct, easily recognizable changes in the amplitude of LES electrical activity. These changes depend on the type of the substance being swallowed and are most prominent with solid food. Changes in LES electrical activity can potentially be used for automatic eating detection.

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