Modulation of feline esophageal contractions by bolus volume and outflow obstruction

Mittal, R. K.; Ren, Junlong; McCallum, Richard W.; Shaffer, Hubert A.; Sluss, J.

doi:10.1152/ajpgi.1990.258.2.g208

Cited by 59 publications

(50 citation statements)

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“…Alternatively, application of CPAP effectively leads to increased esophageal outflow resistance (18). Based on previous studies, one might, therefore, have expected peristaltic velocity to slow rather than increase (7,23). The reason for the increase in velocity observed in our study and the discrepancy with the previous findings remain unclear.…”

Section: Effect Of Cpap On the Esophageal Bodycontrasting

confidence: 72%

The impact of continuous positive airway pressure on the lower esophageal sphincter

Shepherd

Holloway

Hillman

et al. 2007

American Journal of Physiology-Gastrointestinal and Liver Physi

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The lower esophageal sphincter (LES) is the primary barrier to gastroesophageal reflux. Reflux is associated with periods of LES relaxation, as occurs during swallowing. Continuous positive airway pressure (CPAP) has been shown to reduce reflux in individuals with and without sleep apnea, by an unknown mechanism. The aim of this study was to determine the effect of CPAP on swallow-induced LES relaxation. Measurements were made in 10 healthy, awake, supine individuals. Esophageal (Pes), LES (Ples), gastric (Pg), and barrier pressure to reflux (Pb ϭ Ples Ϫ Pg) were recorded using a sleeve catheter during five swallows of 5 ml of water. This was repeated at four levels of CPAP (0, 5, 10, and 15 cmH 2O). Pressures were measured during quiet breathing and during the LES relaxation associated with a swallow. Duration of LES relaxation was also recorded. During quiet breathing, CPAP significantly increased end-expiratory Pes, Ples, Pg, and Pb (P Ͻ 0.05). The increase in Pb was due to a disproportionate increase in Ples compared with Pg (P Ͻ 0.05). During a swallow, CPAP increased nadir Ples, Pg, and Pb and decreased the duration of LES relaxation (4.1 s with 0-cmH 2O CPAP to 1.6 s on 15-cmH2O CPAP, P Ͻ 0.001). Pb increased with CPAP by virtue of a disproportionate increase in Ples compared with Pg. This may be due to either reflex activation of LES smooth muscle, or nonspecific transmission of pressure to the LES. The findings suggest CPAP may make the LES less susceptible to reflux by increasing Pb and decreasing the duration of LES relaxation. lower esophageal sphincter relaxation; esophageal function; gastroesophageal reflux GASTROESOPHAGEAL REFLUX IS common, with ϳ20% of the general community reporting reflux symptoms on a weekly basis (19). Nocturnal reflux has been reported to occur in 9 -11% of the population (9) and may be particularly harmful to the esophagus because of the associated prolonged acid clearance time (5). Obstructive sleep apnea (OSA) is an aggravating factor for nocturnal reflux, presumably because of the development during obstructive events of pressure gradients across the lower esophageal sphincter (LES) that favor reflux.The LES is a high-pressure zone located between the esophagus and stomach, which acts as a barrier to reflux. Pressure within the sphincter is generated by contraction of esophageal smooth muscle and of the crural diaphragm during inspiration.Baseline LES pressure (Ples) fluctuates with respiration, increasing during inspiration as a consequence of diaphragm contraction. In normal, healthy individuals, relaxation of the LES is initiated by swallowing and lasts until the esophageal peristaltic contraction reaches the sphincter segment. Such relaxation is essential to allow passage of the swallowed bolus from the esophagus to the stomach, but may also result in stomach contents entering the esophagus. The LES may also relax in the absence of esophageal peristaltic contraction. Such transient LES relaxations, which usually occur in response to gastric distension (12), underlie ...

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Section: Effect Of Cpap On the Esophageal Bodycontrasting

confidence: 72%

The impact of continuous positive airway pressure on the lower esophageal sphincter

Shepherd

Holloway

Hillman

et al. 2007

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…There is some thought that the dysmotility relates to destruction of the myenteric plexus or vagus nerve by direct invasion of the tumor or paraneoplastic effects of the tumor. However, the manometric findings may simply result from severe esophageal outflow obstruction, as similar findings have been reported in pseudoachalasia due to a compressing pancreatic pseudocyst [3], and abnormal bolus transport has been demonstrated in animal models of esophageal outflow obstruction [4]. To date, no cases of nutcracker esophagus in patients with esophageal adenocarcinoma have been reported.…”

Section: Discussionsupporting

confidence: 68%

Esophageal Adenocarcinoma: Pseudo-Nutcracker Esophagus

et al. 2008

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“…Instances of short-segment achalasia were reported before the advent of HRM 35 , and in these cases the absent peristalsis observed before treatment was a consequence of EGJ obstruction. This phenomenon was demonstrated by Mittal et al 36 in cats by placing ligatures around the LES, which resulted in failed peristalsis with increasing degrees of outflow obstruction. In that model, peri stalsis promptly returns after ligature removal 37 .…”

Section: Achalasia With Preserved Peristalsismentioning

confidence: 83%

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Kahrilas

Bredenoord

Fox

et al. 2017

Nat Rev Gastroenterol Hepatol

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High-resolution manometry (HRM), along with the analysis algorithms characterized in the Chicago Classification (CC) first proposed in 2008, have led to a major restructuring of the classification of oesophageal motility disorders. The inherently quantitative output of HRM devices fuelled enthusiastic expectation among motility experts that these advances would add a level of precision to the diagnosis of oesophageal motility disorders that was not previously possible. Nowhere was this advance more evident than in our concept of achalasia, now differentiated into subtypes as a direct result of HRM. Coincident with the assimilation of HRM into clinical practice was the development of a major therapeutic intervention for the management of oesophageal motility disorders, per-oral endoscopic myotomy (POEM). Not only does the POEM procedure provide a therapeutic option for myotomy with reduced morbidity relative to laparoscopic or open myotomy, but it also enables a calibrated intervention that is customized to patient-specific physiology. Together, these develop ments fostered an increasing emphasis on targeting therapy to specific aspects of oesophageal dysfunction, as measured by physiological testing, rather than discrete diagnoses. Again, nowhere is this evolution more evident than in our strategies for managing achalasia. This Consensus Statement examines the effect of HRM on our current understanding of oesophageal motility disorders with a focus on how this technology has affected the diagnosis, epidemiology and management of achalasia and achalasia-like syndromes. on behalf of the International Working Group for Disorders of Gastrointestinal Motility and FunctionAbstract | High-resolution manometry (HRM) and new analysis algorithms, summarized in the Chicago Classification, have led to a restructured classification of oesophageal motility disorders. This advance has led to increased detection of clinically relevant disorders, in particular achalasia. It has become apparent that the cardinal feature of achalasia -impaired lower oesophageal sphincter (LES) relaxation -can occur in several disease phenotypes: without peristalsis (type I), with pan-oesophageal pressurization (type II), with premature (spastic) distal oesophageal contractions (type III), or with preserved peristalsis (outlet obstruction). Furthermore, no manometric pattern is perfectly sensitive or specific for achalasia caused by a myenteric plexopathy, and there is no biomarker for this pathology. Consequently, physiological testing reveals other syndromes not meeting achalasia criteria that also benefit from therapies formerly reserved for achalasia. These findings have become particularly relevant with the development of a minimally invasive technique for performing a long oesophageal myotomy, the per-oral endoscopic myotomy (POEM). Optimal management is to render treatment in a phenotype-specific manner; that is, POEM calibrated to patient-specific physiology for spastic achalasia and the spastic disorders, and more conservative strategies...

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Modulation of feline esophageal contractions by bolus volume and outflow obstruction

Cited by 59 publications

References 0 publications

The impact of continuous positive airway pressure on the lower esophageal sphincter

The impact of continuous positive airway pressure on the lower esophageal sphincter

Esophageal Adenocarcinoma: Pseudo-Nutcracker Esophagus

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

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