Asymmetry of lower esophageal sphincter pressure: is it related to the muscle thickness or its shape?

Liu, J.; Parashar, Varun; Mittal, Ravinder K.

doi:10.1152/ajpgi.1997.272.6.g1509

Cited by 32 publications

(34 citation statements)

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“…Despite the fact that this measurement was one dimensional, it was proportional to the EGJ cross-sectional area and, hence, reflective of the compliance of the EGJ. Studies evaluating EGJ anatomy using endoscopic ultrasound reveal that the EGJ takes on a nearly circular or elliptical shape during balloon distension (10). Compliance of the EGJ is otherwise difficult to measure, because it is a relatively short anatomical segment and the barostat bag volume mainly localizes either distally in the stomach or proximally in the esophageal lumen.…”

Section: Experimental Protocolmentioning

confidence: 99%

Esophagogastric junction distensibility: a factor contributing to sphincter incompetence

Pandolfino

Shi

Curry

et al. 2002

American Journal of Physiology-Gastrointestinal and Liver Physi

132

118

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Kahrilas. Esophagogastric junction distensibility: a factor contributing to sphincter incompetence. Am J Physiol Gastrointest Liver Physiol 282: G1052-G1058, 2002 10.1152/ ajpgi.00279.2001.-To quantify the effect of hiatus hernia (HH) on esophagogastric junction (EGJ) distensibility, eight normal subjects and nine gastroesophageal reflux disease (GERD) patients with HH were studied with concurrent manometry, fluoroscopy, and stepwise controlled barostatic distention of the EGJ. The minimal barostatic pressure required to open the EGJ during the interswallow period was determined. Thereafter, barium swallows were imaged in 5-mmHg increments of intrabag pressure. EGJ diameter and length were measured at each pressure during deglutitive relaxation. The EGJ opening diameter was greater in hernia patients compared with normal subjects during deglutitive relaxation at all pressures, and EGJ length was 23% shorter. EGJ opening pressure among hernia patients was lower than normal subjects during the interswallow period. In conclusion, the EGJ of GERD patients with HH was more distensible and shorter than normal subjects. These findings partially explain why HH patients are predisposed to reflux by mechanisms other than transient lower esophageal sphincter relaxations, sustain greater volumes of refluxate, and have a reduced ability to discriminate gas from liquid reflux. hiatus hernia; gastroesophageal reflux disease THE CARDINAL ABNORMALITY of gastroesophageal reflux disease (GERD) is incompetence of the esophagogastric junction (EGJ) to reflux of gastric secretions. This functional compromise can be attributable to perturbation of a number of anatomical or physiological components of the EGJ, including the intrinsic lower esophageal sphincter (LES), the extrinsic compression of the distal esophagus at the diaphragmatic hiatus, the intra-abdominal location of the LES, or the physiology of transient LES relaxations (tLESRs). Physiological investigations suggest that the net result of these perturbations is an increased number of acid reflux events by three mechanisms: 1) tLESR, 2) strain-induced reflux in the setting of a hypotensive LES, or 3) free reflux during periods of low LES pressure or deglutitive relaxation (1,12,19).Gaining acceptance as a cofactor in the pathogenesis of GERD is anatomical distortion of the EGJ inclusive of, but not limited to, hiatus hernia (7,9,13,14). When examining GERD in the context of hiatus hernia, certain distinctions become evident. Patients with more severe forms of GERD, such as erosive esophagitis and Barrett's metaplasia, almost invariably have a hiatus hernia (2, 18), and GERD patients with hiatus hernia have increased esophageal acid exposure compared with patients without hiatus hernia (8, 18). The mechanistic profile for reflux in hiatus hernia patients is also distinct. Whereas tLESRs can account for up to 90% of reflux events in normal subjects or in patients without hiatus hernia, patients with hiatus hernia have a more heterogeneous mechanistic profile with reflux episod...

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Section: Experimental Protocolmentioning

confidence: 99%

Esophagogastric junction distensibility: a factor contributing to sphincter incompetence

Pandolfino

Shi

Curry

et al. 2002

American Journal of Physiology-Gastrointestinal and Liver Physi

132

118

View full text Add to dashboard Cite

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“…Simultaneous recording of the esophageal pH, pressure, and HFIUS images revealed a sustained contraction of the longitudinal muscle of the esophagus (SEC) prior to the onset of pain events. Interestingly, this sustained contraction of the longitudinal muscle was not associated with a sustained increase in esophageal pressure [24] .…”

Section: High-frequency Ultrasoundmentioning

confidence: 84%

“…There is a marked increase in the thickness of both circular and longitudinal muscle layers during esophageal contraction. The detailed analysis of the ultrasound images and concurrent pressure recordings reveals a close temporal correlation between the changes in pressure and muscle thickness during contraction [24][25][26] . Nicosia et al [27] proved that the thickening of both circular and longitudinal muscle layers observed on US images is the result of longitudinal muscle contraction.…”

Section: High-frequency Ultrasoundmentioning

confidence: 88%

New Techniques to Evaluate Esophageal Function

Sifrim

Blondeau²

2006

Dig Dis

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Classical techniques like videofluoroscopy, stationary manometry and ambulatory 24-hour pH-metry are routinely used in the clinic to study patients with dysphagia, chest pain and reflux-related symptoms. Although many patients can be accurately diagnosed and their therapy successfully guided with these techniques, in many other patients, non-obstructive dysphagia or chest pain cannot be attributed to clear fluoroscopic or manometric abnormalities. Furthermore, ambulatory 24-hour pH-metry often shows a poor association between spontaneous acid reflux events and esophageal or extraesophageal symptoms, particularly in patients ‘on’ treatment. Non-obstructive dysphagia can be assessed with high-resolution manometry to detect segmental disturbances of peristalsis, increase in pressure gradient across the lower esophageal sphincter (LES) or abnormal axial movement of the LES during esophageal spasm. Impedance evaluation of bolus transit is a non-radiological method that can evaluate the functional relevance of manometric abnormalities. Patients with non-cardiac chest pain that do not respond to proton pump inhibitor therapy can be further assessed with intraluminal high-frequency ultrasound to detect sustained esophageal contractions of the longitudinal muscle layer. Impedance planimetry, with multimodal esophageal stimulation, may contribute to evaluate the sensitivity to mechanical, thermal and chemical stimuli. Finally, patients with persistent symptoms of gastroesophageal reflux in spite of adequate treatment with proton pump inhibitors may still have weakly acidic reflux and/or bile reflux associated with their symptoms. These types of refluxates can now be detected with combinations of pH-impedance or pH-Bilitec monitoring. This review will describe the available new techniques to evaluate patients with non-obstructive dysphagia, non-cardiac chest pain and persistent gastroesophageal reflux symptoms.

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“…Traditionally, sphincters were studied by pull-through and stationary manometry techniques, by the Dent sleeve, and more recently, using high-resolution manometry or highdefinition manometry [2][3][4]. Manometry and the Dent sleeve proved useful for showing phenomena such as transient lower sphincter relaxations and increased lower esophageal sphincter (LES) tone in patients with achalasia, and have gained widespread use in physiology and clinical laboratories around the world.…”

Section: Technical Improvements and Development In Assessment Of Gi Smentioning

confidence: 99%

Functional lumen imaging of the gastrointestinal tract

et al. 2015

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This nonsystematic review aims to describe recent developments in the use of functional lumen imaging in the gastrointestinal tract stimulated by the introduction of the functional lumen imaging probe. When ingested food in liquid and solid form is transported along the gastrointestinal tract, sphincters provide an important role in the flow and control of these contents. Inadequate function of sphincters is the basis of many gastrointestinal diseases. Despite this, traditional methods of sphincter diagnosis and measurement such as fluoroscopy, manometry, and the barostat are limited in what they can tell us. It has long been thought that measurement of sphincter function through resistance to distension is a better approach, now more commonly known as distensibility testing. The functional lumen imaging probe is the first medical measurement device that purports in a practical way to provide geometric profiling and measurement of distensibility in sphincters. With use of impedance planimetry, an axial series of cross-sectional areas and pressure in a cathetermounted allantoid bag are used for the calculation of distensibility parameters. The technique has been trialed in many valvular areas of the gastrointestinal tract, including the upper esophageal sphincter, the esophagogastric junction, and the anorectal region. It has shown potential in the biomechanical assessment of sphincter function and characterization of swallowing disorders, gastroesophageal reflux disease, eosinophilic esophagitis, achalasia, and fecal incontinence. From this early work, the functional lumen imaging technique has the potential to contribute to a better and more physiological understanding of narrowing regions in the gastrointestinal tract in general and sphincters in particular.

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Asymmetry of lower esophageal sphincter pressure: is it related to the muscle thickness or its shape?

Cited by 32 publications

References 0 publications

Esophagogastric junction distensibility: a factor contributing to sphincter incompetence

Esophagogastric junction distensibility: a factor contributing to sphincter incompetence

New Techniques to Evaluate Esophageal Function

Functional lumen imaging of the gastrointestinal tract

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