Document Detail

Response of the upper esophageal sphincter to esophageal distension is affected by posture, velocity, volume, and composition of the infusate.
MedLine Citation:
PMID:  22248662     Owner:  NLM     Status:  MEDLINE    
BACKGROUND & AIMS: Studies of the pressure response of the upper esophageal sphincter (UES) to simulated or spontaneous gastroesophageal reflux have shown conflicting results. These discrepancies could result from uncontrolled influence of variables such as posture, volume, and velocity of distension. We characterized in humans the effects of these variables on UES pressure response to esophageal distension.
METHODS: We studied 12 healthy volunteers (average, 27 ± 5 years old; 6 male) using concurrent esophageal infusion and high-resolution manometry to determine UES, lower esophageal sphincter, and intraesophageal pressure values. Reflux events were simulated by distal esophageal injections of room temperature air and water (5, 10, 20, and 50 mL) in individuals in 3 positions (upright, supine, and semisupine). Frequencies of various UES responses were compared using χ(2) analysis. Multinomial logistical regression analysis was used to identify factors that determine the UES response.
RESULTS: UES contraction and relaxation were the overriding responses to esophageal water and air distension, respectively, in a volume-dependent fashion (P < .001). Water-induced UES contraction and air-induced UES relaxation were the predominant responses among individuals in supine and upright positions, respectively (P < .001). The prevalence of their respective predominant response significantly decreased in the opposite position. Proximal esophageal dp/dt significantly and independently differentiated the UES response to infusion with water or air.
CONCLUSIONS: The UES response to esophageal distension is affected by combined effects of posture (spatial orientation of the esophagus), physical properties, and volume of refluxate, as well as the magnitude and rate of increase in intraesophageal pressure. The UES response to esophageal distension can be predicted using a model that incorporates these factors.
Arash Babaei; Kulwinder Dua; Sohrab Rahimi Naini; Justin Lee; Omar Katib; Ke Yan; Raymond Hoffmann; Reza Shaker
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-01-13
Journal Detail:
Title:  Gastroenterology     Volume:  142     ISSN:  1528-0012     ISO Abbreviation:  Gastroenterology     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-04-06     Completed Date:  2012-05-31     Revised Date:  2014-09-24    
Medline Journal Info:
Nlm Unique ID:  0374630     Medline TA:  Gastroenterology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  734-743.e7     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Chi-Square Distribution
Esophageal Sphincter, Upper / physiology*
Linear Models
Logistic Models
Manometry / methods*
Models, Biological
Muscle Contraction*
Muscle Relaxation*
Odds Ratio
Patient Positioning*
Predictive Value of Tests
Supine Position
Water / administration & dosage*
Young Adult
Grant Support
1UL1RR031973/RR/NCRR NIH HHS; 2T32DK061923-06/DK/NIDDK NIH HHS; 5 P01 DK068051-05/DK/NIDDK NIH HHS; 5R01DK025731-29/DK/NIDDK NIH HHS; P01 DK068051/DK/NIDDK NIH HHS; P01 DK068051-05/DK/NIDDK NIH HHS; R01 DK025731/DK/NIDDK NIH HHS; R01 DK025731-29/DK/NIDDK NIH HHS; T32 DK061923/DK/NIDDK NIH HHS; T32 DK061923-06/DK/NIDDK NIH HHS; UL1 RR031973/RR/NCRR NIH HHS; UL1 RR031973-01/RR/NCRR NIH HHS
Reg. No./Substance:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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