Mechanics of Sphincter Action. STUDIES ON THE LOWER ESOPHAGEAL SPHINCTER

Biancani, Piero; Goyal, Raj K.; Phillips, Aris; Spiro, Howard M.

doi:10.1172/jci107494

Cited by 46 publications

(7 citation statements)

References 12 publications

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“…Because force of closure and tension continue to increase within the range tested, the diameter of optimum tension development is larger than 1 cm and far from closure. These observations are in complete agreement with the data obtained in the rat LES (3).…”

Section: Introductionsupporting

confidence: 93%

Pressure tension, and force of closure of the human lower esophageal sphincter and esophagus.

Biancani¹,

Zabinski²,

Behar³

1975

J. Clin. Invest.

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A B S T R A C T The mechanical characteristics of the circular muscle of the human lower esophageal sphincter and esophagus were studied in subjects with competent and incompetent sphincters. Pressure-diameter curves were constructed by producing various degrees of circumferential stretch with pressure-measuring probes of increasing diameter. The circumferential membrane tension (force of closure) and the circumferential stress (muscle tension) of the circular muscle layer were also calculated from these data.The pressure-diameter curves of competent and incompetent sphincters were different in magnitude and shape. Incompetent sphincters had lower pressures at all diameters, with pressures gradually increasing with larger probe diameter. In contrast for competent sphincters the pressure was highest near closure, with an initial decline and then an increase in pressure with increasing probe diameter. Both shape and magnitude of pressure-diameter curves of competent and incompetent sphincters were interchangeable when manipulated by pharmacologic agents. Urecholine increased the pressures and changed the incompetent pressure-diameter curve to the levels of the competent sphincter; conversely, Pro-Banthine decreased pressures and changed the shape of the competent pressure-diameter curve to the levels of the incompetent sphincter.Force of closure and circular muscle tension curves of competent and incompetent sphincters were similar in shape but were higher at all diameters for competent sphincters. Force of closure and circular muscle tension increased with larger probe diameter. However, the diameter of optimal tension development was larger than the largest probe used and certainly far from closure.Fundoplication increased the magnitude and changed the shape of the incompetent pressure-diameter curve

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Section: Introductionsupporting

confidence: 93%

Pressure tension, and force of closure of the human lower esophageal sphincter and esophagus.

Biancani¹,

Zabinski²,

Behar³

1975

J. Clin. Invest.

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“…Recent developments have allowed the use of micromanometric evaluation of aerodigestive reflexes in preterm infants ( 9 – 12 ), as well as the longitudinal assessment of these neuromotor markers relevant to the esophageal sphincters and esophageal body ( 13 – 16 ). The upper esophageal sphincter (UES), a conglomeration of skeletal muscles, and the lower esophageal sphincter (LES) constituted by highly specialized smooth muscle, ( 17 – 20 ) provide important barrier functions for airway protection and esophageal clearance during swallowing and GER events. Specifically, aerodigestive protective reflexes such as UES contraction safeguards against retrograde GER ascent, and LES relaxation facilitates luminal clearance during peristalsis.…”

Section: Introductionmentioning

confidence: 99%

Gestational and postnatal modulation of esophageal sphincter reflexes in human premature neonates

et al. 2015

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BackgroundEffects of gestational age (GA) and postnatal maturation on upper and lower esophageal sphincter (UES and LES) reflex development remains unclear. We hypothesized very-preterm (VPT) born neonates (< 32 weeks GA) have delayed maturation of UES contractile reflex (UESCR) and LES relaxation reflex (LESRR) vs. preterm (PT) born (32–37 weeks GA) neonates.MethodsUsing provocative manometry, effects of 1263 graded mid-esophageal stimuli (air, liquid) on sensory-motor characteristics of UESCR and LESRR were investigated in 24 VPT-born and 12 PT-born neonates (37.8±0.6 vs 38.9±0.4 weeks PMA respectively, P=0.14).ResultsIn response to liquid stimuli (vs. air), VPT-born neonates displayed prolonged UESCR and LESRR response latencies (P<0.001) and prolonged UESCR and LESRR durations (P<0.01); unlike PT-born neonates, who exhibit prolonged LESRR response latency (P<0.01), but similar UESCR and LESRR durations (P=0.2). Differences were noted in LESRR duration in VPT vs. PT neonates for air stimuli (P=0.04). With liquid stimuli, increasing GA was associated with decreasing response onset latencies to UESCR and LESRR (P<0.05), and increasing LESRR duration (P=0.02).ConclusionsUsing GA as categorical or continuous variable, vagus-mediated mechano-sensitive and liquid-sensitive reflex characteristics of UESCR and LESRR are distinct; LESRR differs with varying intrauterine maturation suggesting inhibitory modulation progresses with advancing maturation.

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“…Force–velocity analysis demonstrated that both the work and power generated during esophageal and LES muscle contraction were determined by (1) the initial muscle length produced by the preload, (2) the afterload against which the muscle was contracting, and (3) the contractility of inotropism of the muscle . The tension–diameter curves of the LES muscle showed that optimal tension development did not occur at or near sphincter closure but at much wider diameters . Swallow and esophageal distension can induce LES relaxations due to axial stretch …”

Section: Normal Esophageal Anatomy Function and Biomechanical Propementioning

confidence: 99%

“…55 The tension-diameter curves of the LES muscle showed that optimal tension development did not occur at or near sphincter closure but at much wider diameters. 56 Swallow and esophageal distension can induce LES relaxations due to axial stretch. 57…”

Section: Normal Esophageal Anatomy Function and Biomechanical Propementioning

confidence: 99%

Diabetes‐induced mechanophysiological changes in the esophagus

Zhao

Gregersen

2016

Annals of the New York Academy of Sciences

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Esophageal disorders are common in diabetes mellitus (DM) patients. DM induces mechanostructural remodeling in the esophagus of humans and animal models. The remodeling is related to esophageal sensorimotor abnormalities and to symptoms frequently encountered by DM patients. For example, gastroesophageal reflux disease (GERD) is a common disorder associated with DM. This review addresses diabetic remodeling of esophageal properties and function in light of the Esophagiome, a scientifically based modeling effort to describe the physiological dynamics of the normal, intact esophagus built upon interdisciplinary approaches with applications for esophageal disease. Unraveling the structural, biomechanical, and sensory remodeling of the esophagus in DM must be based on a multidisciplinary approach that can bridge the knowledge from a variety of scientific disciplines. The first focus of this review is DM-induced morphodynamic and biomechanical remodeling in the esophagus. Second, we review the sensorimotor dysfunction in DM and how it relates to esophageal remodeling. Finally, we discuss the clinical consequences of DM-induced esophageal remodeling, especially in relation to GERD. The ultimate aim is to increase the understanding of DM-induced remodeling of esophageal structure and sensorimotor function in order to assist clinicians to better understand the esophageal disorders induced by DM and to develop better treatments for those patients.

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Mechanics of Sphincter Action. STUDIES ON THE LOWER ESOPHAGEAL SPHINCTER

Cited by 46 publications

References 12 publications

Pressure tension, and force of closure of the human lower esophageal sphincter and esophagus.

Pressure tension, and force of closure of the human lower esophageal sphincter and esophagus.

Gestational and postnatal modulation of esophageal sphincter reflexes in human premature neonates

Diabetes‐induced mechanophysiological changes in the esophagus

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