Document Detail


Pressure morphology of the relaxed lower esophageal sphincter: the formation and collapse of the phrenic ampulla.
MedLine Citation:
PMID:  22114118     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
This study aimed to apply novel high-resolution manometry with eight-sector radial pressure resolution (3D-HRM technology) to resolve the deglutitive pressure morphology at the esophagogastric junction (EGJ) before, during, and after bolus transit. A hybrid HRM assembly, including a 9-cm-long 3D-HRM array, was used to record EGJ pressure morphology in 15 normal subjects. Concurrent videofluoroscopy was used to relate bolus movement to pressure morphology and EGJ anatomy, aided by an endoclip marking the squamocolumnar junction (SCJ). The contractile deceleration point (CDP) marked the time at which luminal clearance slowed to 1.1 cm/s and the location (4 cm proximal to the elevated SCJ) at which peristalsis terminated. The phrenic ampulla spanned from the CDP to the SCJ. The subsequent radial and axial collapse of the ampulla coincided with the reconstitution of the effaced and elongated lower esophageal sphincter (LES). Following ampullary emptying, the stretched LES (maximum length 4.0 cm) progressively collapsed to its baseline length of 1.9 cm (P < 0.001). The phrenic ampulla is a transient structure comprised of the stretched, effaced, and axially displaced LES that serves as a "yield zone" to facilitate bolus transfer to the stomach. During ampullary emptying, the LES circular muscle contracts, and longitudinal muscle shortens while that of the adjacent esophagus reelongates. The likely LES elongation with the formation of the ampulla and shortening to its native length after ampullary emptying suggest that reduction in the resting tone of the longitudinal muscle within the LES segment is a previously unrecognized component of LES relaxation.
Authors:
Monika A Kwiatek; Frédéric Nicodème; John E Pandolfino; Peter J Kahrilas
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2011-11-23
Journal Detail:
Title:  American journal of physiology. Gastrointestinal and liver physiology     Volume:  302     ISSN:  1522-1547     ISO Abbreviation:  Am. J. Physiol. Gastrointest. Liver Physiol.     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-01-25     Completed Date:  2012-04-23     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  100901227     Medline TA:  Am J Physiol Gastrointest Liver Physiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  G389-96     Citation Subset:  IM    
Affiliation:
Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Biomechanics / physiology
Deglutition / physiology
Esophageal Sphincter, Lower / anatomy & histology*,  physiology*
Female
Fluoroscopy / methods
Humans
Male
Manometry / methods
Middle Aged
Muscle Contraction / physiology
Muscle, Smooth / physiology
Peristalsis / physiology
Pressure*
Young Adult
Grant Support
ID/Acronym/Agency:
R01 DK-079902/DK/NIDDK NIH HHS; R01 DK-56033/DK/NIDDK NIH HHS; R01 DK056033/DK/NIDDK NIH HHS; R01 DK079902-04/DK/NIDDK NIH HHS
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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