Deglutitive responses in the gastroesophageal sphincter of healthy human beings

Abstract

Resting pressure and deglutitive changes of pressure in the gastroesophageal sphincter of 12 healthy subjects were recorded as a tiny balloon-covered pressure transducer and open-tipped tubes connected to transducers were withdrawn through the sphincter by 0.5-cm stages. The pressures—both resting and deglutitive—detected by the balloon unit were of greater magnitude than those recorded by the open-tipped tubes. A reduction in pressure indicating relaxation was the outstanding deglutitive pressure change recorded in the subhiatal portion of the sphincter. In the segment of the sphincter at the hiatus, the subsequent contraction was as prominent as the relaxation. As the units traversed the suprahiatal portion of the sphincteric zone, the reduction of pressure (relaxation) became progressively less and the rise of pressure (contraction) with deglutition became greater. Contraction alone occurred at the points farthest orad. Measurements of time intervals from the start of swallowing in the pharynx indicated a caudad peristaltic progression of both relaxation and contraction through the gastroesophageal sphincteric zone. Submitted on December 21, 1959

Response of the Physiologic Gastroesophageal Sphincter to Increased Intra-abdominal Pressure *

“…At and below the hiatus a small zone was found during quiet respiration where the mean pressures during relaxation of the sphincter were higher than fundic pressure. This small band has been postulated to be guardian pressure against regurgitation at the moment when the resting barrier has disappeared (12). During abdominal compression, the number of relaxations during which pressure in the sphincter fell below fundic pressure increased, resulting in the temporary disappearance of the small pressure barrier between the fundus of the stomach and the tubular esophagus.…”

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

“…Many articles dealing with patterns of intraluminal pressure at the gastroesophageal junction either state or imply that the high pressure recorded within the junctional zone provides a pressure barrier separating the adjacent cavities (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). It has also been suggested that a high resting sphincter pressure denotes a competent sphincter, and conversely, a low pressure an incompetent sphincter (1)(2)(3)(4)(11)(12)(13)(14).…”

Normal deglutitive responses of the human lower oesophageal sphincter

“…This sphincter is readily detectable by manometry as a zone of high pressure interposed between stomach and oesophagus (Fyke, Code, and Schlegel, 1956;Atkinson, Edwards, Honour, and Rowlands, 1957; Botha, Astley, and Carre, 1957). The normal response of the high pressure zone to deglutition is relaxation, that is to say, a transient decrease in pressure (Fyke et al, 1956;Botha et al, 1957;Kelley. Wilbur, Schlegel, and Code, 1960).…”

“…Wilbur, Schlegel, and Code, 1960). In the more proximal part of the high pressure zone, relaxation is followed by contraction, which is of greater duration than that in the oesophagus (Fyke et al, 1956;Wilbur et al, 1960). Sphincteric relaxation and contraction are integral parts of the overall oesophageal motor response to swallowing.…”

“…It is pertinent to consider whether the high pressure zone, in response to deglutition, functions as a single unit, or, alternatively, whether relaxation and contraction pass through this zone in a progressive fashion. Support for the latter possibility was provided by Kelley et al (1960), who studied these phenomena 352 with unperfused catheters and with a miniature balloon-covered oesophageal transducer.…”