Abstract
BackgroundGastroesophageal reflux disease (GERD) is associated with lower esophageal sphincter (LES) incompetence. In some patients, GERD is refractory to acid reduction therapy which is the main treatment for GERD. So far, medications that can increase LES tone are few. Arecae pericarpium (A. pericarpium) is a medication in Traditional Chinese Medicine known to promote intestinal motility.MethodsWe investigated the effect of A. pericarpium extracts on porcine LES motility. In addition, we used tetrodotoxin (TTX) and atropine to study the underlying mechanism of A. pericarpium extracts-induced contractions of LES.ResultsThe results of this study showed that A. pericarpium extracts and their main active ingredient, arecoline, can induce the contractions of porcine LES sling and clasp muscles in a dose-response manner. TTX did not have an inhibitory effect on the contractions induced by A. pericarpium extracts and arecoline in LES. However, atropine significantly inhibited A. pericarpium extracts- and arecoline-induced contractions of LES.ConclusionA. pericarpium extracts can induce the contractions of porcine LES in a dose dependent manner, possibly through muscarinic receptors, and hence, may be worth developing as an alternative therapy for GERD.
Highlights
Gastroesophageal reflux disease (GERD) is associated with lower esophageal sphincter (LES) incom‐ petence
Measurement of arecoline‐induced contractions of porcine LES In order to check the effect of arecoline on LES, 300 nM arecoline was added after a 30-min equilibration period, and 1 μM arecoline was added when the contraction reaches a peak equilibration induced by 300 nM arecoline
A significant inhibitory effect of atropine on arecolineinduced contractions of LES sling and clasp muscles was observed, compared to arecoline alone as shown in Fig. 4B (p = 0.005 (300 nM) and 0.0003 (1 μM) in sling muscles and 0.0001 (300 nM) and 0.00001 (1 μM) in clasp muscles, n = 4 and 7 in sling and clasp muscles respectively). These results reveal that A. pericarpium extracts and their main active ingredient, arecoline, caused the contractions of porcine LES sling and clasp muscles in a dose-response manner
Summary
Gastroesophageal reflux disease (GERD) is associated with lower esophageal sphincter (LES) incom‐ petence. Arecae pericarpium (A. pericarpium) is a medication in Traditional Chinese Medicine known to promote intestinal motility. Incompetence of the lower esophageal sphincter (LES), including decreased tone or repeated transient relaxation, is considered a major contributing factor to GERD [1, 2]. Up to 30% of patients show obstinate symptoms despite the use of proton pump inhibitors (PPIs), which reduce esophageal acid exposure [3]. This is partly due to Arecae pericarpium (A. pericarpium) is the dried pericarp of Areca catechu L. that is common in Southern China, India, Philippines, Taiwan, and Southeast Asian countries.
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