“Squeeze” vs. Resistance: An Evaluation of the Mechanism of Sphincter Competence*

Harris, Lauran D.; Pope, Charles E.

doi:10.1172/jci105101

Cited by 92 publications

(54 citation statements)

References 15 publications

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“…Manometry has proven to be a useful tool in classic cases, but for early detection better measurement methods to determine sphincter function are needed. Harris and Pope (12) found that sphincters do not necessarily need to squeeze or contract tightly to be competent. Therefore resistance to distention should be the prime determinant of sphincteric strength.…”

Section: The Lower Esophageal Sphincter (Les)mentioning

confidence: 99%

The functional lumen imaging probe (FLIP) for evaluation of the esophagogastric junction

McMahon

Frøkjær²,

Kunwald³

et al. 2007

American Journal of Physiology-Gastrointestinal and Liver Physi

134

136

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P, Drewes AM, Gregersen H. The functional lumen imaging probe (FLIP) for evaluation of the esophagogastric junction. Am J Physiol Gastrointest Liver Physiol 292: G377-G384, 2007. First published August 31, 2006; doi:10.1152/ajpgi.00311.2006.-There is a need for new methods to study the dynamics of the esophagogastric junction (EGJ). The aims were to verify the efficacy and usefulness of a "functional lumen imaging probe" (FLIP) for the evaluation of the EGJ. Eight healthy volunteers (6 men), median age 26 (21-35) yr, and two achalasia patients underwent the FLIP procedure. The EGJ was located by manometry. The FLIP measured eight cross-sectional areas (CSAs) 4 mm apart together with the pressure inside a saline-filled cylindrical bag. The data showed the geometric profile of the EGJ reconstructed in a video animation of its dynamic activity. A plot of curve-fitted data for the smallest CSA vs. pressure after balloon distension indicated that the pressure increased from 18 cmH 2O at a CSA of 38 mm 2 to a pressure of 37 cmH2O at a CSA of 230 mm 2 for the healthy controls. In one achalasia patient (unsuccessfully treated with dilations), the CSA never rose above the minimal measurable value despite the pressure increasing to 50 cmH2O. In another achalasia patient (successfully treated with dilations), the pressure only reached 15 cmH2O despite opening to a CSA of 250 mm 2 . In conclusion, FLIP represents the first dynamic technique to profile the function and anatomy of the EGJ. The method can be used practically to evaluate difficult cases of EGJ dysfunction and may provide a role in evaluating patients before and after therapies for diseases affecting the EGJ such as achalasia and gastroesophageal reflux disease. esophagus; competence; distensibility; cross-sectional area; functional imaging THE LOWER ESOPHAGEAL SPHINCTER (LES) is not solely responsible for impeding the flow between the esophagus and the stomach. The crural diaphragm encircles ϳ2 cm of the esophagogastric junction (EGJ), and the sling or oblique fibers of the stomach also contribute to the mechanism (15, 21). Esophageal and gastric motility, pressures in the abdominal and thoracic cavities, and the exact location of the EGJ all play a role in defining its function. The anatomy and behavior of the EGJ also change with time and body posture (20). The EGJ is a very dynamic mechanical structure. A lot of knowledge about the anatomy of the EGJ has been assembled over the last 40 years, but much of our limited understanding of the behavior has been related to manometric studies. Intraluminal pressure recording is the current gold standard for determining the motility characteristics of the esophagus. Although manometry provides useful information on the location of the EGJ and on phasic motility within the lumens of the digestive tract, it may be more restrictive in what it can tell us about sphincteric regions and their dynamics.Two classic diseases involving the EGJ are gastroesophageal reflux disease (GERD) and achalasia. Achalasia is an esophageal ...

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Section: The Lower Esophageal Sphincter (Les)mentioning

confidence: 99%

The functional lumen imaging probe (FLIP) for evaluation of the esophagogastric junction

McMahon

Frøkjær²,

Kunwald³

et al. 2007

American Journal of Physiology-Gastrointestinal and Liver Physi

134

136

View full text Add to dashboard Cite

show abstract

“…Prior studies were performed with uninfused open-tipped catheters, a method shown to be inadequate for recording the entire range of gastrointestinal sphincter pressure (4,5). Harris and Pope have demonstrated that pressures recorded by this technique were influenced by mucosa sealing the recording orifice (12). This produced significant artifacts in interpreting LES pressure.…”

Section: Introductionmentioning

confidence: 99%

Role of gastrin supersensitivity in the pathogenesis of lower esophageal sphincter hypertension in achalasia

Cohen¹,

Lipshutz²,

Hughes³

1971

J. Clin. Invest.

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A B STRA CT Intraluminal manometric studies were carried out in 19 patients with untreated achalasia and in 20 normals. Lower esophageal sphincter (LES) pressure was 50.5 ±4.6 mm Hg in patients with achalasia as compared with 19.4 ±1.3 mm Hg in the normal group.In both groups, the LES pressure was lowered when exogenous 0.1 N HCl was placed into the stomach. Although the nadir of pressure attained with acid suppression was the same, the per cent inhibition was significantly greater in patients with achalasia. Serum gastrin levels were the same in the two groups studied. The patients with achalasia, pre-and postpneumatic dilatation, showed a supersensitivity to exogenous intravenous gastrin I, as compared with normals. These data suggest that high, acid-suppressible levels of LES pressure, in patients with achalasia, are due to supersensitivity to endogenous gastrin. INTRODUCTIONIn patients with achalasia, dysfunction of the lower esophageal sphincter (LES)' plays a major role in the pathogenesis of impaired esophageal emptying. Although this point is well recognized, a clear understanding of the pathophysiology of this dysfunction is not available. The classic concept of a normotensive LES, which fails to relax upon deglutition (1, 2) has been questioned (3). It has been suggested that LES dysfunction consisted of a marked elevation in LES pressure and a limited, but distinct, ability to relax upon deglutition. By this latter concept, LES hypertension would play a major role in the impairment of esophageal emptying. It is the purpose of this study to utilize a method of proven

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“…Few parents would likely enroll their infant in such a study today. In the other study, 15 healthy, adult males were hooked up to pressure transducers while defecating -either naturally or while intensely squeezing (47). Apparently the study was meant to determine the sphincter pressure needed for expulsion.…”

Section: Figure 10mentioning

confidence: 99%

Reflecting on 80 years of excellence

Savla¹

2004

J. Clin. Invest.

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“Squeeze” vs. Resistance: An Evaluation of the Mechanism of Sphincter Competence*

Cited by 92 publications

References 15 publications

The functional lumen imaging probe (FLIP) for evaluation of the esophagogastric junction

The functional lumen imaging probe (FLIP) for evaluation of the esophagogastric junction

Role of gastrin supersensitivity in the pathogenesis of lower esophageal sphincter hypertension in achalasia

Reflecting on 80 years of excellence

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