Neuromuscular control of esophageal peristalsis

Abstract

The esophagus is a muscular conduit connecting the pharynx and the stomach. Its function is controlled by an intrinsic nervous system and by input from the central nervous system through the vagus nerve. Peristalsis in its striated muscle is directed by sequential vagal excitation arising in the brain stem, whereas peristalsis in its smooth muscle involves complex interactions among the central and peripheral neural systems and the smooth muscle elements of the esophagus. The peripheral neuronal elements responsible for producing esophageal off-response, relaxation of the lower esophageal sphincter, and hyperpolarization of the circular esophageal muscle cells reside in the myenteric plexus of the esophagus. For many years these nerves were considered nonadrenergic and noncholinergic because the inhibitory neurotransmitter released on their activation was unknown. We now know that nitric oxide or a related compound is that inhibitory neurotransmitter. The primary excitatory neurotransmitter controlling esophageal motor function is acetylcholine. Some disorders of esophageal motor function, including diffuse esophageal spasm and achalasia, may result from defects in or an imbalance between these excitatory and inhibitory neuromuscular systems.

Effect of Atrial Fibrillation Ablation on Gastric Motility

“…21 The parasympathetic efferents from the anterior and posterior esophageal plexuses supply the upper and lower esophageal sphincter and also synapse with the intrinsic myenteric plexus of the esophagus and thereby regulate the sphincters and peristalsis of the esophagus. 22,23 Branches from the anterior and posterior vagal trunk (formed from the periesophageal plexi) supply the vagal efferents to the stomach and the pyloric sphincter. 24 The posterior vagal trunk forms the celiac plexus, branches of which supply the pancreas.…”

Results of the laparoscopic Heller-Dor procedure for pediatric esophageal achalasia

“…Esophageal achalasia is a functional disorder of the esophagus characterized by abnormal motility of the esophageal body associated with delayed, or absent, mechanical and not neurogenic relaxation of the lower esophageal sphincter [4,10,17,19,20]. The incidence is about 0.3-11/10 6 /year with a prevalence of about 80/10 6 inhabitants and only 5% are younger than 15 years of age [15,18,22].…”

Postnatal changes in vagal control of esophageal muscle contractions in rats

“…This is in contrast to striated muscles in the adult esophagus, which are directly innervated by the vagus (Goyal and Chaudhury, 2008;Izumi et al, 2003;Neuhuber et al, 2006;Park and Conklin, 1999;Shiina et al, 2006). It was of interest to determine whether muscles, especially smooth muscles, in the neonatal esophagus are directly innervated by the vagus or innervated through a mediation of intrinsic nerves in a manner similar to that in the stomach and intestines.…”

“…In dogs and rodents including rats, mice and hamsters, the muscle layer of the esophagus consists largely of striated muscle fibers. The striated muscle fibers are innervated exclusively by excitatory vagal efferents that arise from motor neurons originating in the nucleus ambiguus and terminate on motor endplates (Cunningham and Sawchenko, 1990;Goyal and Chaudhury, 2008;Jean, 2001;Neuhuber et al, 2006;Park and Conklin, 1999).…”