Transient Lower Esophageal Sphincter Relaxation and Esophageal Motor Response

Schneider, Juliane; Küper, Markus A.; Königsrainer, Alfred; Brücher, Björn L.D.M.

doi:10.1016/j.jss.2009.02.021

Cited by 28 publications

(26 citation statements)

References 35 publications

(29 reference statements)

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“…Similar to the present study, esophageal longitudinal muscle contraction (LMC) occurred after the onset of LES relaxation and was correlated with acid reflux 24. However, in 2010, Schneider et al22 reported that esophageal LMC is restricted to the distal esophagus, begins before TLESR onset, and is sustained during the entire TLESR duration. The authors proposed that LMC of the esophagus may be the primary motor event, and that the LES and crural diaphragm could be secondary 22.…”

Section: Discussionsupporting

confidence: 78%

“…However, the majority of studies report a similar rate of TLESR in healthy subjects and GERD patients 5-8. Schneider et al22 reported that the frequency of TLESR was more than twice as high in patients with GERD compared to healthy control group 22. Thus, there is debate about whether the frequency of TLESR is increased in patients with GERD.…”

Section: Discussionmentioning

confidence: 99%

“…However, in 2010, Schneider et al22 reported that esophageal LMC is restricted to the distal esophagus, begins before TLESR onset, and is sustained during the entire TLESR duration. The authors proposed that LMC of the esophagus may be the primary motor event, and that the LES and crural diaphragm could be secondary 22. This result was significant because it suggested for the first time that LMC could be used to develop new medications for GERD.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Specific Movement of Esophagus During Transient Lower Esophageal Sphincter Relaxation in Gastroesophageal Reflux Disease

Kim¹,

Hong²,

Han³

et al. 2013

J Neurogastroenterol Motil

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Background/AimsTransient lower esophageal sphincter relaxation (TLESR) is the main mechanism of gastroesophageal reflux disease (GERD). The aim of this study was to investigate the characteristics of transient lower esophageal sphincter movement in patients with or without gastroesophageal reflux by high-resolution manometry (HRM).MethodsFrom June 2010 to July 2010, we enrolled 9 patients with GERD (GERD group) and 9 subjects without GERD (control group), prospectively. The manometry test was performed in a semi-recumbent position for 120 minutes following ingestion of a standardized, mixed liquid and solid meal. HRM was used to identify the frequency and duration of TLESR, esophageal shortening length from incomplete TLESR, upper esophageal sphincter (UES) response, and the related esophageal motor responses during TLESR.ResultsTLESR occurred in 33 in the GERD group and 34 in the control group after 120 minutes following food ingestion. Duration of TLESR and length of esophageal shortening did not differ between 2 groups. UES pressure increase during TLESR was mostly detected in patients with GERD, and UES relaxation was observed frequently in the control group during TLESR. TLESR-related motor responses terminating in TLESR were predominantly observed in the control group.ConclusionsIncreased UES pressure was noted frequently in the GERD group, suggesting a mechanism for preventing harmful reflux, which may be composed mainly of fluid on the larynx or pharynx. However, patients with GERD lacked the related motor responses terminating in TLESR to promote esophageal emptying of refluxate.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Specific Movement of Esophagus During Transient Lower Esophageal Sphincter Relaxation in Gastroesophageal Reflux Disease

Kim¹,

Hong²,

Han³

et al. 2013

J Neurogastroenterol Motil

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“…TLESRs are generally believed to be normal physiological events because they are frequently observed in healthy subjects and are involved in the mechanism of belching or venting of gas from the stomach . Previous studies have proven that patients with gastroesophageal reflux disease (GERD) have an increased number of TLESRs . In addition, TLESRs are more likely to be associated with acid reflux in GERD patients.…”

Section: Introductionmentioning

confidence: 99%

24‐hour monitoring of transient lower esophageal sphincter relaxation events by long‐term high‐resolution impedance manometry in normal volunteers: The “mirror phenomenon”

Jell

Hüser

et al. 2019

Neurogastroenterology Motil

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Background The aim of this study was to investigate the frequency and circadian changes in transient lower esophageal sphincter relaxations (TLESRs) in normal volunteers using 24‐hour high‐resolution impedance manometry (HRIM). Methods Fifteen volunteers underwent HRIM. TLESRs were recorded during the mealtime, 2‐hour postprandial, daytime, and supine periods. The catheter was firmly secured to the nose, and subjects went home, ate normal meals, and continued routine daily activities. Key Results Successful recordings were obtained in 11 volunteers. Overall, 1083 TLESRs were documented; the average occurrence was 4.2/h, and the duration was 21.0 ± 5.2 seconds. The majority of the TLESRs occurred during the 2‐hour postprandial (42.7%) and daytime (31.5%) periods, while 10.2% and 15.6% occurred during the mealtime and supine periods, respectively. Eight hundred and eighty‐six (81.8%) TLESRs were associated with reflux. Overall, 25.5% of TLESRs were preceded by partial secondary peristalsis (PSP), while 74.5% were preceded by nothing. Terminating events included primary peristalsis (PP; 40.3%), PSP (42.8%), full secondary peristalsis (FSP; 8.2%), or nothing (8.7%). Both preceding and terminating events periodically changed throughout the four periods. One hundred and twelve (10.3%) TLESRs with both preceding and terminating events of PSP, presenting as a “mirror phenomenon,” were documented. The majority of these TLESRs occurred during the supine (70.5%). Conclusions & Inferences Transient lower esophageal sphincter relaxations are common physiological motor events in normal volunteers; these events have certain circadian rhythms, as do the events that precede and terminate TLESR events. A special “mirror phenomenon” is observed when both the preceding and terminating events are PSP.

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“…Die chirurgische Sichtweise einer präopera tiven Radiochemotherapie beim ESCC beinhaltet vielfältige Variablen, die nach folgend beleuchtet werden. [10,11]. ESCCPatienten können zudem anamnestisch andere Plattenepithelkarzi nome im aerodigestiven Trakt aufweisen.…”

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Plattenepithelkarzinom des Ösophagus

Brücher¹

2009

Chirurg

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Esophageal squamous cell carcinomas (ESCCs) are an interdisciplinary challenge in terms of diagnosis, multimodal and/or surgical treatment procedures and also postoperative management as they are often associated with multiple comorbidities. The gold standard for a curative treatment approach is radical surgery, which is standardized and can be carried out with acceptable morbidity and mortality rates. ESCCs are usually diagnosed at locally advanced tumor stages and neoadjuvant treatment procedures are therefore used. Patients who respond to neoadjuvant therapy (responders) have a significantly better survival rate. The neoadjuvant studies that are currently available need to be critically assessed as they do not include response as an end point. In this context the WHO clinical response evaluation that has been used up to now is questionable. The histopathological findings with percentage proportions of residual tumor cells represent the gold standard for evaluating the response. Positron-emission tomography as a response criterion is predictive for the histopathological response and survival. ESCC patients who are classified as non-responders do not appear to benefit from surgical resection. In the future the results of a response evaluation and of pretreatment molecular biological tests could have a place in the process of pretherapeutic and peritherapeutic oncological decision-making in patients with ESCCs.

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Transient Lower Esophageal Sphincter Relaxation and Esophageal Motor Response

Cited by 28 publications

References 35 publications

Specific Movement of Esophagus During Transient Lower Esophageal Sphincter Relaxation in Gastroesophageal Reflux Disease

Specific Movement of Esophagus During Transient Lower Esophageal Sphincter Relaxation in Gastroesophageal Reflux Disease

24‐hour monitoring of transient lower esophageal sphincter relaxation events by long‐term high‐resolution impedance manometry in normal volunteers: The “mirror phenomenon”

Plattenepithelkarzinom des Ösophagus

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