Abstract
Background: Through rhythmic variations, the diaphragm influence lower esophageal sphincter (LES) pressure acting as an external sphincter. LES pressure recording is characterized by increased pressure in inspiration due to contraction of the diaphragmatic crura that involves the sphincter. Aim: To describe a method of measuring LES pressure during standardized inspiratory maneuvers with increasing loads. Methods: The study population comprised of eight healthy female volunteers (average age of 31.5 years). An esophageal high-resolution manometry and impedance system was used for measuring the LES pressure during 3-second inspiratory efforts under 12, 24 and 48 cm H2O loads (Threshold maneuvers). Results: There was a significant difference between the average maximum LES pressure and the average maximum basal LES pressure during the first (76.19±17.92 difference, p=0.0008), second (86.92±19.01 difference, p=0.0004), and third seconds of the maneuver (90.86±17.93 difference, p=0.0002), with 12, 24 and 48 cmH2O loads. Conclusion: This maneuver is a standardization of the inspiratory LES pressure and may better differentiate patients with reflux disease from healthy individuals, and may also be useful for monitoring the treatment of these patients through inspiratory muscle training.
Highlights
The lower esophageal sphincter is a 2-4 cm high pressure zone with intraabdominal and intra-thoracic segments
The pressure inversion point separates the lower esophageal sphincter (LES) segments and the intra-thoracic yields a negative pressure during inhalation
Manometry HRM is a standard method of measuring the pressure gradient across the gastroesophageal junction and its relaxation, allowing accurate diagnosis of diseases associated with hyper or hypotonicity
Summary
The lower esophageal sphincter is a 2-4 cm high pressure zone with intraabdominal and intra-thoracic segments. The pressure inversion point separates the lower esophageal sphincter (LES) segments and the intra-thoracic yields a negative pressure during inhalation. This segment is approximately 0.5 cm long, generally located in the middle of the high pressure zone, and related to the crural diaphragm. The LES normally extends two to four centimeters distal to the inversion point and corresponds to the intra-abdominal segment. The high pressure zone is asymmetrical with the left lateral and posterior pressures significantly higher 7. The diaphragm influences rhythmically the LES pressure, acting as an external sphincter. Its manometric profile is represented by an increase in pressure during inhalation, due to the contraction of the diaphragm that skirts the esophagus 7
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