Role of the Diaphragm in the Genesis of Lower Esophageal Sphincter Pressure in the Cat

Boyle, J. T.; Altschuler, Steven M.; Nixon, Todd E.; Tuchman, David N.; Pack, Allan I.; Cohen, Sidney

doi:10.1097/00132586-198512000-00005

Cited by 33 publications

(45 citation statements)

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“…The rapid fall of LES pressure in association with the DEMG at the end of each maneuver suggests a strong temporal relationship between the two events. Similar to ours, the studies by Welch and Gray (16) and Boyle et al (4) show that the LES pressure increase during spontaneous inspiration is primarily the result of a sphincterlike action of the active diaphragmatic contraction.…”

Section: Discussionsupporting

confidence: 91%

“…Interestingly, the sling fibers from the right crus of the diaphragm are arranged in such a way that they could also exert a sphincteric action at the LES (3). Recent studies suggest that the respiration-induced LES pressure oscillations observed in the cat LES are primarily the result of active diaphragmatic contraction (4). Whether the diaphragmatic contraction could actually enhance the LES pressure in the human, and what the physiological significance of such an action might be, are not clear.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Electrical and mechanical activity in the human lower esophageal sphincter during diaphragmatic contraction.

Mittal¹,

Rochester²,

McCallum³

1988

J. Clin. Invest.

173

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To determine the effect of contraction of the diaphragm on the lower esophageal sphincter (LES) pressure, we studied eight healthy volunteers during spontaneous breathing, maximal inspiration, and graded inspiratory efforts against a closed airway (Muller's maneuver). Electrical activity of the crural diaphragm (DEMG) was recorded from bipolar esophageal electrodes, transdiaphragmatic pressure (Pdi) than Pdi and correlated with it in a linear fashion (P < 0.001). We conclude that the contraction of the diaphragm exerts a sphincteric action at the LES, and that this effect is an important component of the antireflux barrier.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Electrical and mechanical activity in the human lower esophageal sphincter during diaphragmatic contraction.

Mittal¹,

Rochester²,

McCallum³

1988

J. Clin. Invest.

173

View full text Add to dashboard Cite

show abstract

“…Two patients of Group A and one of Group B refused to continue the study; one patient of Group A and one of Group B were excluded because their oesophageal motility studies were considered technically inadequate; finally two patients of Group A with nerve phrenic crush during surgery were excluded. That was because the LES and diaphragmatic sphincter are anatomically superimposed on each other, and therefore it is difficult to discern whether the intraluminal pressure is related to LES or diaphragmatic sphincter contraction [12,13].…”

Section: Resultsmentioning

confidence: 99%

The effects of lung resection on physiological motor activity of the oesophagus†

Fiorelli

Vicidomini

Milione

et al. 2013

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES:To assess the modifications of oesophageal function after major lung resection and whether these modifications are correlated with the extent of resection ( pneumonectomy vs others). METHODS:In the last 5 years, 40 consecutive surgical patients with lung cancer were prospectively enrolled and divided in two groups: Group A (n = 20) patients scheduled for elective pneumonectomy and Group B (n = 20) for more limited resections (lobectomy or bilobectomy). In addition to routine evaluations, all patients underwent preoperative (within 5 days) and postoperative (6 months) oesophageal manometry to assess the lower oesophageal sphincter (LES), the oesophageal body and the upper oesophageal sphincter functions. Symptoms scoring questionnaires were recorded for each patient and the oesophageal dislocation assessed by radiological examinations.RESULTS: Thirty-three (15 of Group A and 18 of Group B) patients completed the study. After operation, we found that LES resting pressure was significantly lower in Group A compared with Group B (P = 0.01); conversely, the relaxing pressure resulted as being higher in Group A than in Group B (P = 0.01). In Group A compared with Group B, a significant reduction of amplitude and that of wave duration of oesophageal contractions were seen at the upper (0.0001 and 0.02, respectively), middle (0.0003 and 0.002, respectively) and lower (0.0001 and 0.0004, respectively) oesophageal body. In addition, 12 of 15 (80%) patients of Group A and 3 of 18 (17%) of Group B presented a lack of regular peristaltic movement (P = 0.001). Despite chest CT scan showing a shift of the oesophagus in 11 of 15 (73%) and 2 of 18 (11.1%) patients of Groups A and B (P = 0.001), the oesophagus dislocation resulted 'severe' on barium swallow study in only two patients of Group A. The manometric alterations were subclinical; heartburn was recorded in three patients (two of Group A and one of Group B) and epigastric pain in four (two for each group). No other symptoms were observed.CONCLUSIONS: Pneumonectomy may cause significant oesophageal motility disorders that are mostly subclinical. Thus, this type of surgery should not be denied to patients if required to treat their cancer.

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“…1 When a hiatal hernia is present, the two components of the high-pressure zone can be separated: the oesophagogastric junction (OGJ) and the LOS are then located proximal to the diaphragm. Relaxation of the LOS occurs during each swallow, allowing a bolus to pass into the stomach.…”

Section: Resultsmentioning

confidence: 99%

Review article: the clinical relevance of transient lower oesophageal sphincter relaxations in gastro-oesophageal reflux disease

Kessing

Conchillo

Bredenoord

et al. 2011

Alimentary Pharmacology &Amp; Therapeutics

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Role of the Diaphragm in the Genesis of Lower Esophageal Sphincter Pressure in the Cat

Cited by 33 publications

References 0 publications

Electrical and mechanical activity in the human lower esophageal sphincter during diaphragmatic contraction.

Electrical and mechanical activity in the human lower esophageal sphincter during diaphragmatic contraction.

The effects of lung resection on physiological motor activity of the oesophagus†

Review article: the clinical relevance of transient lower oesophageal sphincter relaxations in gastro-oesophageal reflux disease

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