Primary Peristalsis and Esophagogastric Junction (EGJ) Pressure Following a Transient Lower Esophageal Sphincter Relaxation (TLESR) Are Accompanied by a Forceful Contraction

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.

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Lower esophageal sphincter relaxation reflex kinetics: effects of peristaltic reflexes and maturation in human premature neonates

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00289.2010 ◽

2010 ◽

Vol 299 (6) ◽

pp. G1386-G1395 ◽

Cited By ~ 38

Author(s):

Eneysis M. Pena ◽

Vanessa N. Parks ◽

Juan Peng ◽

Soledad A. Fernandez ◽

Carlo Di Lorenzo ◽

...

Keyword(s):

Lower Esophageal Sphincter ◽

Response Latency ◽

Postnatal Maturation ◽

Premature Neonates ◽

Relaxation Period ◽

Peristaltic Reflex ◽

Primary Peristalsis ◽

Lower Esophageal Sphincter Relaxation ◽

Sensory Motor ◽

Esophageal Sphincter

We defined the sensory-motor characteristics of the lower esophageal sphincter relaxation (LESR) (stimulus threshold volume, response onset, and relaxation period, relaxation magnitude, nadir) during maturation in human neonates. We hypothesized that LESR kinetics differs during maturation and with peristaltic reflex type. Basal and adaptive esophageal motility testing was performed ( N = 20 premature neonates) at 34.7 and 39.1 wk ( time 1 and time 2). Effects of midesophageal provocation with graded stimuli ( N = 1,267 stimuli, air and liquids) on LESR kinetics during esophagodeglutition response (EDR) and secondary peristalsis (SP) were analyzed by mixed models. Frequency of LESR with basal primary peristalsis were different during maturation ( P = 0.03). During adaptive responses with maturation, 1) the frequencies of peristaltic reflexes and LESR were similar; 2) liquid stimuli resulted in a shorter LESR response latency and LESR nadir and greater LESR magnitude (all P < 0.05); 3) media differences were noted with LESR response latency (air vs. liquids, P < 0.02); and 4) infusion flow rate-LESR were different ( P < 0.01 for air and liquids). Mechanistically, 1) frequency of LESR was greater during peristaltic reflexes at both times (vs. none, P < 0.0001); 2) LESR response latency, duration, and time to complete LESR were longer with EDR (all P < 0.05, vs. SP at time 2); and 3) graded stimulus volume LESR were different for air and liquids ( P < 0.01). In conclusion, sensory-motor characteristics of LESR depend on the mechanosensitive properties of the stimulus (media, volume, flow), type of peristaltic reflex, and postnatal maturation. Maturation modulates an increased recruitment of inhibitory pathways that favor LESR.

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Tu1787 Primary Peristalsis and Esophagigastric Junction (EGJ) Pressure, Following a Transient Lower Esophageal Sphincter Relaxation (TLESR), Are Accompanied by a Forceful Contraction

Gastroenterology ◽

10.1016/s0016-5085(13)63144-3 ◽

2013 ◽

Vol 144 (5) ◽

pp. S-845

Author(s):

Noriyuki Kawami ◽

Katsuhiko Iwakiri ◽

Hirohito Sano ◽

Yuriko Tanaka ◽

Choitsu Sakamoto

Keyword(s):

Lower Esophageal Sphincter ◽

Primary Peristalsis ◽

Lower Esophageal Sphincter Relaxation ◽

Esophageal Sphincter

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Physiological and pathological roles of the accommodation response in lower esophageal sphincter relaxation during wet swallows

Scientific Reports ◽

10.1038/s41598-021-87052-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kazumasa Muta ◽

Eikichi Ihara ◽

Shohei Hamada ◽

Hiroko Ikeda ◽

Masafumi Wada ◽

...

Keyword(s):

Clinical Practice ◽

High Resolution ◽

Observational Study ◽

Lower Esophageal Sphincter ◽

Relaxation Function ◽

Esophagogastric Junction ◽

Prospective Observational Study ◽

Outflow Obstruction ◽

High Resolution Manometry ◽

Esophageal Sphincter

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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