| Transient lower oesophageal sphincter relaxation in achalasia: everything but LOS relaxation. | |
| | |
MedLine Citation:
|
PMID: 19552630 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
In conducting clinical high-resolution oesophageal pressure topography (HROPT) studies we observed that after subjects sat upright between series of supine and upright test swallows, they frequently had a transient lower oesophageal sphincter relaxation (TLOSR). When achalasia patients were studied in the same protocol, they exhibited a similar HROPT event leading to the hypothesis that achalasics had incomplete TLOSRs. We reviewed clinical HROPT studies of 94 consecutive non-achalasics and 25 achalasics. Studies were analyzed for a TLOSR-like event during the study and, when observed, that TLOSR-like event was characterized for the degree and duration of distal oesophageal shortening, the degree of LOS relaxation, associated crural diaphragm (CD) inhibition, oesophageal pressurization and upper oesophageal sphincter (UOS) relaxation. About 64/94 (68%) non-achalasics and 15/24 (63%) of achalasics had a pressure topography event after the posture change characterized by a prolonged period of distal oesophageal shortening and/or LOS relaxation. Events among the non-achalasics and achalasics were similar in terms of magnitude and duration of shortening and all were associated with CD inhibition. Similar proportions had associated non-deglutitive UOS relaxations. The only consistent differences were the absence of associated LOS relaxation and the absence of HROPT evidence of reflux among the achalasics leading us to conclude that their events were incomplete TLOSRs. Achalasic patients exhibit a selective defect in the TLOSR response suggesting preservation of all sensory, central and efferent aspects of the requisite neural substrate with the notable exception of LOS relaxation, a function of inhibitory (nitrergic) myenteric plexus neurons. |
| | |
Authors:
|
M A Kwiatek; J Post; J E Pandolfino; P J Kahrilas |
Publication Detail:
|
Type: Journal Article; Research Support, N.I.H., Extramural Date: 2009-06-23 |
Journal Detail:
|
Title: Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society Volume: 21 ISSN: 1365-2982 ISO Abbreviation: Neurogastroenterol. Motil. Publication Date: 2009 Dec |
Date Detail:
|
Created Date: 2009-11-12 Completed Date: 2010-01-25 Revised Date: 2011-03-03 |
Medline Journal Info:
|
Nlm Unique ID: 9432572 Medline TA: Neurogastroenterol Motil Country: England |
Other Details:
|
Languages: eng Pagination: 1294-e123 Citation Subset: IM |
Affiliation:
|
Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611-2951, USA. monika.kwiatek@gmail.com |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adolescent Adult Aged Aged, 80 and over Child Diaphragm / physiopathology Esophageal Achalasia / physiopathology* Esophageal Sphincter, Lower / physiopathology* Female Humans Male Manometry Middle Aged Muscle Contraction / physiology Muscle Relaxation / physiology Pressure Young Adult |
| Grant Support | |
ID/Acronym/Agency:
|
R01 DC000646-10/DC/NIDCD NIH HHS; R01 DC00646/DC/NIDCD NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Screening of edentulous patients in a dental school population using the prosthodontic diagnostic in...
Next Document: Irritable bowel syndrome is strongly associated with generalized anxiety disorder: a community study...