Nature and Kinetics of Inhibition of Lower Esophageal Sphincter Pressure by Glucagon

Jaffer, S.S.; Makhlouf, G.M.; Schorr, B.; Zfass, Alvin M.

doi:10.1016/s0016-5085(19)32923-3

Cited by 64 publications

(9 citation statements)

References 13 publications

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“…Therefore, neurotensin, or a neurotensin metabolite, might be responsible for the decrease in the LES pressure after a fatty meal. Several hormones released after food intake, such as gastrin, secretin, cholecystokinin, and glucagon, have been shown to influence the LES pressure (Nebel & Castell 1972, Giles et al 1969, Castell & Harris 1970, Cohen & Lipshutz 1971, Resin et al 1973, Jaffer et al 1974, but it has not been established whether these hormones are of any physiological importance in the regulation of the LES pressure (Grossman 1973, Cohen & Lipshutz 1974, Sturdevant 1974, Henderson et al 1978.…”

Section: Discussionmentioning

confidence: 99%

Plasma concentration of neurotensin‐like immunoreactivity (NTLI) and lower esophageal sphincter (LES) pressure in man following infusion of (GIn4)‐neurotensin

Rosell

Thor

Rökaeus

et al. 1980

Acta Physiologica Scandinavica

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(Gln4)-neurotensin was infused i.v. for 5 to 70 min at 3 different infusion rates (6, 12 and 18 pmol X kg-1 X min-1, respectively) in 19 male volunteers, aged 26-47. The plasma concentration of neurotensin-like immunoreactivity (NTLI), the lower esophageal sphincter (LES) pressure, blood pressure, heart rate. ECG and blood glucose concentration were measured. The volunteers did not report any subjective effects during the infusion. Following infusion periods of 30 min or more the volunteers often reported bowel movements starting 5 min or more after cessation of the infusion. Neither blood pressure nor heart rate changed significantly. No changes were noted in the continuous ECG or in the blood glucose concentration. Apparent steady state levels of about 300 pM NTLI were reached at about 40 min during infusion of 12 pmol X kg-1 X min-1 (Gln4)-neurotensin. In all volunteers the LES pressure was significantly reduced within 5 min of starting the infusion. In 6 volunteers 12 pmol X kg-1 X min-1 (Gln4)-neurotensin was infused i.v. for 5 min. The LES pressure decreased significantly (P less than 0.01) from 13.7 +/- 1.3 mmHg to 5.3 +/- 0.8 mmHg. The decrease in the LES pressure occurred at plasma NTLI concentrations of approximately 50 pM, i.e. at levels below those obtained in man after a meal or the ingestion of fat. The present data further support the hypothesis that in man plasma neurotensin, or a neurotensin metabolite is an endocrine hormone involved in the postprandial regulation of the motor functions of the gastrointestinal tract.

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Section: Discussionmentioning

confidence: 99%

Plasma concentration of neurotensin‐like immunoreactivity (NTLI) and lower esophageal sphincter (LES) pressure in man following infusion of (GIn4)‐neurotensin

Rosell

Thor

Rökaeus

et al. 1980

Acta Physiologica Scandinavica

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“…This effect has been used extensively during endoscopy for better visualization and administration of therapy in the intestine and biliary tract. Early studies assessed the effect of intravenous glucagon on esophageal motor function, specifically evaluating lower esophageal sphincter (LES) resting pressure [4,5]. These studies and others have demonstrated in humans and animals that a significant reduction in LES resting pressure is achieved [4][5][6][7][8][9].…”

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confidence: 99%

Assessment of the Predictors of Response to Glucagon in the Setting of Acute Esophageal Food Bolus Impaction

2004

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Esophageal food impactions are frequently seen in endoscopic practice. Glucagon is known to relax the lower esophageal sphincter and has been used with variable success to treat food impactions. We retrieved clinical information of all patients with acute food impactions who attended the emergency room from 1975 to 2000 from the Mayo diagnostic database. Data were abstracted on age, sex, body mass index, relevant prior medical history, food type ingested (meat, bread, vegetable, or other), duration of symptoms at presentation, dosage (in mg) of glucagon, outcome including success of glucagon or spontaneous passage, and endoscopic findings. A total of 222 cases of food impaction were identified, of whom 106 patients (48%) received glucagon, average 1 mg. In glucagon responders, meat was less likely to be the offending food type, accounting for 70% (glucagon responders) vs. 90% (in nonresponders) ( p = 0.03), while responders were less likely to have esophageal rings/strictures detected on subsequent EGD compared with nonresponders, 0% (glucagon responders) vs. 31% (nonresponders) ( p = 0.05). In the patients that did not receive glucagon, spontaneous resolvers had a shorter duration of symptoms at presentation, 3.3 h vs. 12.4 h ( p = 0.07) and were less likely to have an organic esophageal obstruction detected on EGD, 0% vs. 21%. There were no significant differences between the resolvers and nonresolvers in terms of age, gender, BMI, and prior medical history. Conservative management of acute food bolus obstruction, either with or without glucagon, is most successful in the absence of a fixed esophageal obstruction. An impacted meat bolus is more likely to require intervention for removal than other food types. These clinical predictors should be considered before administration of glucagon.

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“…However, when assessing the original reports, only measurements of lower esophageal resting pressures before and after administration of glucagon were carried out [2,3,8,9]. The percentage of LES relaxation was not recorded despite its important therapeutic implication.…”

Section: Discussionmentioning

confidence: 99%

“…This effect has been used extensively during endoscopy for better visualization and administration of therapy in the intestine and biliary tract. Early studies that assessed the effect of intravenous glucagon on esophageal motor function evaluated only the lower esophageal sphincter (LES) resting pressure [2,3]. These studies and others have demonstrated in humans and animals that, after a latency period of 30-60 sec postadministration of glucagon, a significant reduction in LES resting pressure is achieved [2][3][4][5][6][7][8].…”

mentioning

confidence: 99%

Effect of Doses of Glucagon Used to Treat Food Impaction on Esophageal Motor Function of Normal Subjects

et al. 1999

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We studied 10 normal subjects to determine the effect of doses of intravenous glucagon used to treat food impaction on esophageal motor function. With a multilumen assembly perfused by a low compliance pneumohydraulic infusion pump, esophageal manometry was performed during baseline and after randomized administration of 0. 25, 0.5, and 1 mg intravenous glucagon. Mean proximal and distal amplitudes of contraction, proximal and distal amplitude of contraction duration, lower esophageal sphincter (LES) resting pressure, percentage of LES relaxation, and glucagon-related side effects were evaluated. No effect on proximal amplitude of contraction and proximal or distal esophageal contraction duration was noted. Mean amplitude of contraction in the distal esophagus was further reduced with increased dosage of glucagon but did not achieve statistical significance. Mean LES resting pressure was significantly reduced after 0.25 mg (18.7 +/- 1.8 vs. 10.2 +/- 1.5 mmHg, p = 0.0001) and further reduced after 0.5 mg (5.9 +/- 1.2 mmHg, p = 0.0009). Mean LES relaxation was significantly reduced after 0. 25 mg (93.1 +/- 2.4% vs. 63.6 +/- 8.8%, p = 0.0031). The 1-mg dose versus the 0.5-mg did not provide further reduction in any LES function parameters. One subject experienced transient nausea after 0.5 mg, and 4 subjects experienced nausea after 1 mg glucagon. In conclusion, increased doses of glucagon further reduce mean distal esophageal amplitude of contraction. Although maximum reduction in mean LES resting pressure was achieved with 0.5 mg, it did not provide any potential therapeutic advantage over 0.25 mg glucagon. Nausea is a common, transient side effect predominantly affecting subjects treated with the 1-mg dose.

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Nature and Kinetics of Inhibition of Lower Esophageal Sphincter Pressure by Glucagon

Cited by 64 publications

References 13 publications

Plasma concentration of neurotensin‐like immunoreactivity (NTLI) and lower esophageal sphincter (LES) pressure in man following infusion of (GIn4)‐neurotensin

Plasma concentration of neurotensin‐like immunoreactivity (NTLI) and lower esophageal sphincter (LES) pressure in man following infusion of (GIn4)‐neurotensin

Assessment of the Predictors of Response to Glucagon in the Setting of Acute Esophageal Food Bolus Impaction

Effect of Doses of Glucagon Used to Treat Food Impaction on Esophageal Motor Function of Normal Subjects

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