The effect of vagotomy on the lower oesophageal sphincter: A manometric study

Angorn, I. B.; Dimopoulos, G.; Hegarty, M. M.; Moshal, M G

doi:10.1002/bjs.1800640704

Cited by 17 publications

(4 citation statements)

References 8 publications

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“…The marked response to small changes in intragastric pressure and the fact that the response was abolished by atropine suggests that the pressure increase in the sphincter was because of sphincteric contraction and not to external mechanical forces such as a diaphragmatic contraction. Truncal vagotomy does not alter the resting lower oesophageal sphincter pressure12 13 and our finding that truncal vagotomy abolishes the response of the sphincter to increased intragastric pressure is in keeping with the work of others using the station pull through technique.3 4 The rise in lower oesophageal sphincter pressure after carbachol, found in patients with truncal vagotomy, indicates that the smooth muscle of the sphincter is capable of contracting when stimulated directly but fails to do so in response to increase of intragastric pressure suggesting interruption of the nervous pathways which mediate the sphincteric response. It is of interest that in patients studied after truncal vagotomy the presence of recurrent duodenal ulcer correlated better with the sphincteric response to intra-abdominal compression than it did with the insulin/pentagastrin gastric secretory ratio, suggesting that the response of the lower oesophageal sphincter to abdominal compression might form a valid test for the completeness of surgical vagotomy.…”

Section: Discussionsupporting

confidence: 76%

Influence of the vagus nerve upon the reflex control of the lower oesophageal sphincter.

Ogilvie¹,

Atkinson²

1984

Gut

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SUMMARY In 24 control patients the lower oesophageal sphincter responded to graded increments in intra-abdominal pressure by a significant and sustained rise in tone. This response was abolished by atropine and was also absent in nine of 11 patients who had previously undergone truncal vagotomy for duodenal ulcer but not in the remaining two who had recurrent ulceration. In six patients studied after proximal gastric vagotomy a variable response was seen. Gastric efferent vagal function was assessed by a combined insulin/pentagastrin gastric secretory test and did not correlate closely with the lower oesophageal sphincteric response to increased intra-gastric pressure. These findings are explicable if it is assumed that truncal vagotomy interrupts the afferent limb of a reflex arc regulating lower oesophageal sphincteric tone.Lower oesophageal sphincter pressure has been shown to increase with a rise in intra-abdominal pressure' 2 and this may represent an important mechanism protecting against gastro-oesophgeal reflux. Whether the vagus nerve is concerned in the reflex control of the lower oesophageal sphincter is uncertain and while some have found that truncal vagotomy abolishes the sphincteric response to increase in intra-abdominal pressure, 3 4 others have failed to do so and have suggested the pressure increase is brought about by diaphragmatic contraction.To investigate the possible role of the vagus in the reflex control of the lower oesophageal sphincter, we have studied the effects of atropine and of truncal and proximal gastric vagotomy upon the response of the lower oesophageal sphincter to increase in intra-abdominal pressure. Methods PATIENTSThe control group consisted of 24 patients (21 men) with a mean age of 43 years (range 30-70 years), who had undergone upper gastrointestinal fibreoptic endoscopy for dyspepsia. Eighteen had chronic

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Section: Discussionsupporting

confidence: 76%

Influence of the vagus nerve upon the reflex control of the lower oesophageal sphincter.

Ogilvie¹,

Atkinson²

1984

Gut

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“…Reflex contraction of the LES occurs with abdominal compression or in association with contractions of the stomach (7,9,21). There is evidence that the increase in LES intraluminal pressure during gastric contraction is mediated by a neural reflex which involves a cholinergic component (1,21). The increase in intraluminal pressure seen in our study, especially the increase in pressure gradient during gastric contractions, could be due to the development of this reflex neural pathway.…”

Section: Discussionmentioning

confidence: 47%

Ontogenic Studies of Gastrointestinal Function. II. Lower Esophageal Sphincter Maturation in Neonatal Beagle Puppies

1982

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SummaryThe purpose of the present study was to investigate the postnatal development of lower esophageal spincter (LES) competence in the beagle and to determine the role of gastrin in LES functional ontogeny. Eleven beagle puppies taken from two litters were studied. All puppies were allowed to suckle during the first 3 postnatal wk. In the 4th wk, all puppies were weaned, and by the 5th wk only solid chow was offered. Intraluminal manometric pressure determinations were obtained in unanesthetized, unsedated puppies using twin-lumen, 1.7 mm OD, 1 mm ID polyvinyl catheters. A 12-15 min baseline period of intraluminal pressure was monitored, after which the puppies received successive doses of 0.03, 0.1, 1.0, and 8.0 pg/kg pentagastrin (PC) SC spaced at 45-min intervals.Progressive increases in LES pressure both during basal periods and during gastric contractions and in gastric fundus (GF) pressures during gastric contractions occurred during the 1st 5 weeks of life. An increase in pressure gradient between the LES and GF during gastric contraction occurred from birth through 5 wk of age. There was no response to 0.1-8.0 pg/kg PG until postnatal days 5-6 when the LES pressure gradient in the basal state increased in response to each of these doses. There was also no significant response by the LES to PG during gastric contraction until days 11-12 when all doses of PG evoked enhancement of LES pressure.These studies suggest that an increase in LES-GF intraluminal pressure gradient develops during the initial 2 postnatal wk in this species and that this development does not involve the hormone gastrin. Later, however, the pressure gradient may depend upon both age and gastrin since a two-way analysis of variance indicated that nit only is LES pressure affected bypostnatal age and by PG dose. but that there is an interaction between ~ostnatal age and PG dose which is significant. By the fifth wk, there was an apparent dose-response effect in which the lower two doses produced increased LES pressure and the larger two doses produced decreased LES pressures. SpeculationGastroesophageal reflux (GER) in some infants may occur when the developmental interplay between endogenous gastrin concentration, increasing sensitivity to gastrin by LES, and sensitivity to gastrin by the muscular stomach proceeds abnormally. Alternatively, either the postnatal increase in LES muscle mass or the maturation of a neural pathway that mediates reflex contraction of the LES during gastric contraction, or both, may be delayed or abnormal in some children with GER. A fourth possible abnormality that may permit GER in still other infants is failure to generate the increasing gastric contraction rate and intraluminal pressures observed to occur in normal development, thus permitting delayed gastric emptying.Functional incompetence of the lower esophageal sphincter (LES) that results in gastroesophageal reflux (GER) is a common problem in infants (6,15,20,23,24,28,29). Healthy term and preterm newborn infants normally regurgitate feedings for ...

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“…The general opinion that this operation does not interfere with gastro-oesophageal function is surprising. Recent work suggests that truncal vagotomy impairs the sphincter response to abdominal compression (Angorn et al, 1977). The subject is, however, controversial.…”

Section: Discussionmentioning

confidence: 99%

The combination of proximal gastric vagotomy with a rotational posterior gastropexy for duodenal ulcer

Hancock¹,

Sankar²,

Old³

et al. 1978

Journal of British Surgery

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(Fuber et al., 1975) We have now applied Maybury's criterion (Maybury et al., 1977) Patients and methodsBetween September 1971 and February 1977, 98 duodenal ulcerpatients had either a proximal gastric vagotomy (46 cases) or a proximal gastric vagotomy combined with a rotational posterior gastropexy (52 cases). Randomization was not carried out because 28 patients with grade 3 oesophageal reflux symptoms had a PGV and gastropexy while only 5 such cases had a PGV alone. Also the PGV series was started 5 months earlier than the PGV and gastropexy series. However, the two groups matched well in respect of age, sex, weight and symptoms.Despite non-randomization, we think the results of the two operations can be fairly compared. It might be argued that the first 10 or so operations constituted a 'learning period' during which vagotomy might be expected to be incomplete. In fact, on insulin testing at 1 year or more postoperatively, only 1 of the first 9 PGV patients (completed before the PGV and gastropexy series was started) was Faber positive (Faber et al., 1975). This compares with 9 Faber positives out of a total of 31 tests carried out in males after PGV. If the runs test for randomness is applied to the Faber positives they are found to be evenly scattered through the group of male PGV insulin tests. Similarly, the runs test shows an even scatter of Maybury positives (Maybury et al., 1977) through the whole group of insulin tests carried out after both PGV and PGV and gastropexy in both males and females. In this respect the series is not non-random.One of us (D. M. H.), who carried out most of the operations, was taught the technique of highly selective vagotomy (HSV) or proximal gastric vagotomy by Professor David Johnston before commencing this work. By this procedure the body, fundus, cardia and lower 4-5 cm of oesophagus are denervated, preserving the nerves of Latarjet to the antrum up to 6-7 crn from the pylorus.In PGV and rotational posterior gastropexy the raw areas that have been dissected in PGV are rotated away from each other by suturing the strong sling fibres of Willis at midanterior gastro-oesophageal junction level to the tough pre-aortic fascia. Two or three good sutures leave the oesophagus under slight tension with the fundus rolled up over its front. At this stage a no. 38-40 stomach tube should pass from the oesophagus into the stomach without let o r hindrance. With the large tube in place the anterior fundoplication (which has formed automatically if the pre-aortic fascia sutures have been correctly inserted) is fixed in place by two to three more sutures between the anterior stomach wall and the oesophagus. The gastro-oesophageal fat pad must be excised as the first step after completion of PGV in order to demonstrate the sling fibres of Willis. This procedure produces an intraabdominal segment of oesophagus witha flapvalve at the gastrooesophageal junction. It also separates nerve twigs (cut during PGV) by traction and rotation at gastro-oesophageal level and rotation at lesser cu...

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The effect of vagotomy on the lower oesophageal sphincter: A manometric study

Cited by 17 publications

References 8 publications

Influence of the vagus nerve upon the reflex control of the lower oesophageal sphincter.

Influence of the vagus nerve upon the reflex control of the lower oesophageal sphincter.

Ontogenic Studies of Gastrointestinal Function. II. Lower Esophageal Sphincter Maturation in Neonatal Beagle Puppies

The combination of proximal gastric vagotomy with a rotational posterior gastropexy for duodenal ulcer

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