Responses of the competent and incompetent lower oesophageal sphincter to pentagastrin and abdominal compression.

Kaye, Michael; Rein, Raquel; Johnson, William W.; Showalter, J. Philip

doi:10.1136/gut.17.12.933

Cited by 14 publications

(5 citation statements)

References 27 publications

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“…In our current study after the meal the belt caused a greater rise in the IGP than in LES pressure causing a significant fall in LES pressure relative to the IGP which is the pressure gradient preventing reflux. This fall in LES pressure relative to the IGP has been reported by some but not all investigators (5,7,8,9,10,11). The fall in LES pressure relative to the IGP in our current study was only apparent after the meal and involved patients with reflux disease and in these respects differed from previous studies.…”

Section: Accepted Manuscriptcontrasting

confidence: 51%

“…Previous investigators have examined the effect of waist belt compression on the manometric characteristics of the lower esophageal sphincter (LES) in both healthy volunteers and patients with reflux disease. The rise in IGP caused by the waist belt is accompanied by a rise in LES pressure though sometimes of a lesser magnitude (5,7,8,9,10,11). Waist belt compression in short term studies does not result in the development of, or aggravation of, hiatus hernia or in increased separation of the intrinsic and extrinsic components of the LES (9,12,13).…”

Section: Background and Aimsmentioning

confidence: 99%

See 1 more Smart Citation

Abdominal Compression by Waist Belt Aggravates Gastroesophageal Reflux, Primarily by Impairing Esophageal Clearance

et al. 2017

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Section: Accepted Manuscriptcontrasting

confidence: 51%

Section: Background and Aimsmentioning

confidence: 99%

Abdominal Compression by Waist Belt Aggravates Gastroesophageal Reflux, Primarily by Impairing Esophageal Clearance

et al. 2017

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“…It was considered that the elevated intraesophageal pressure was not caused by a direct effect of the increase in the intraabdominal pressure through the esophagogastric junction but by the increase in the intrathoracic pressure following elevation of the diaphragm. Some authors reported that the increase in the LESP relative to the atmospheric pressure was higher than that of the intragastric pressure [10,11], whereas others reported that they were similar [12,13]. Controversy remains, but our report supports the latter contention.…”

Section: Discussionsupporting

confidence: 68%

Intraoperative Manometry during Laparoscopic Operation for Esophageal Achalasia: Does Pneumoperitoneum Affect Manometry?

et al. 1996

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The effects of pneumoperitoneum on the lower esophageal sphincter (LES) were evaluated during laparoscopic operation for esophageal achalasia. Intraoperative manometry was performed in three patients who underwent laparoscopic cardiomyectomy with Dor's fundoplication and five patients who underwent laparoscopic cholecystectomy (LC). The LES pressure and the length of the high-pressure zone (HPZ) did not change during pneumoperitoneum in either the achalasia and the LC group. In the achalasia group the LES pressure was sufficiently decreased following completion of cardiomyectomy, and the length of the HPZ was found to be sufficiently long after completion of fundoplication. The postoperative courses of the achalasia patients were uneventful, and they have had no symptoms of achalasia or gastroesophageal reflux since the operation. Accordingly, intraoperative manometry during 12 mmHg pneumoperitoneum was considered to be available for laparoscopic surgery for esophageal achalasia.

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“…There is no doubt that exogenous gastrin increases sphincter pressure (Giles et al, 1969;Cohen and Lipshutz, 1971;Trindade et al, 1975;Kaye et al, 1976) but the evidence that endogenous gastrin is a physiological determinant of sphincter pressure is less convincing (Grossman, 1973;Roszkowski et al, 1973;Farrell et al, 1974;McCall et al, 1975;Dodds et al, 1975a, b;Dent and Hansky, 1976). Central to the controversy is the methodology of LOS pressure measurement.…”

mentioning

confidence: 99%

Lower oesophageal sphincter response to gastrin--pharmacological or physiological?

Henderson¹,

Lidgard²,

Osborne³

et al. 1978

Gut

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SUMMARY The response of the lower oesophageal sphincter (LOS) to intragastric instillation of protein was assessed in 10 healthy volunteers. Sphincter pressures were measured by a rapid pullthrough technique and serum gastrin concentrations during each test were determined by radioimmunoassay. Despite stimulation of gastrin release by protein instillation, no significant change in LOS pressure was observed. However, intravenous pentagastrin (0 25 and 0.5 jig/kg) produced an immediate increase in sphincter pressure, which then returned to the basal level within four minutes. Thus, although pentagastrin is an effective pharmacological stimulant of the sphincter, endogenous gastrin appears not to be a physiological determinant of LOS pressure in man.The role of endogenous gastrin in control of the lower oesophageal sphincter (LOS) is still a subject of controversy. There is no doubt that exogenous gastrin increases sphincter pressure (Giles et al., 1969;Cohen and Lipshutz, 1971;Trindade et al., 1975;Kaye et al., 1976) but the evidence that endogenous gastrin is a physiological determinant of sphincter pressure is less convincing (Grossman, 1973;Roszkowski et al., 1973;Farrell et al., 1974;McCall et al., 1975; Dodds et al., 1975a, b;Dent and Hansky, 1976). Central to the controversy is the methodology of LOS pressure measurement. Most studies have used static pressure recording catheters or a station pull-through technique in which the recording catheter is withdrawn across the sphincter in 1 cm steps, pausing after each step to record LOS pressure during three or four respiratory cycles. Rapid pull-through techniques are now available which minimise error in pressure recording (Dodds etal., 1975a(Dodds etal., , b 1976) and a rapid pull-through method was used in the present study to measure the LOS pressure response to endogenous gastrin release provoked by intragastric instillation of protein. Methods TECHNIQUE OF LOS PRESSURE MEASUREMENT LOS pressure was measured by a rapid pull-through technique based on that described by WaldeckReceived for publication 9 August 1977 (1972) and modified by Osborne and his colleagues (1977). Recordings were made with a single lumen polyvinyl tube which was perfused at 6 ml/min as it was withdrawn across the LOS at 0'9 cm/s. This system was capable of recording a pressure rise rate of 70 mmHg/s when tested on the bench. By convention, LOS pressure is measured as the peak height of the profile relative to intragastric pressure. RESPONSE OF LOS TO PENTAGASTRINFour healthy male volunteers (aged 26-32 years), without a previous history of dyspepsia, were given graded doses of pentagastrin (Peptavlon, ICI) to determine the LOS pressure response. Doses of 0'0625, 0 125, 0-25, and 0 5 jig/kg were used, the pentagastrin being diluted in 10 ml/150 mm sodium chloride solution and injected intravenously over 60 seconds. The four doses were given in a random order which was not known to the subject. LOS pressure was measured every two minutes for 10 minutes before pentagastrin injectio...

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Responses of the competent and incompetent lower oesophageal sphincter to pentagastrin and abdominal compression.

Cited by 14 publications

References 27 publications

Abdominal Compression by Waist Belt Aggravates Gastroesophageal Reflux, Primarily by Impairing Esophageal Clearance

Abdominal Compression by Waist Belt Aggravates Gastroesophageal Reflux, Primarily by Impairing Esophageal Clearance

Intraoperative Manometry during Laparoscopic Operation for Esophageal Achalasia: Does Pneumoperitoneum Affect Manometry?

Lower oesophageal sphincter response to gastrin--pharmacological or physiological?

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