Pharmacologic identification of the lower esophageal sphincter.

Abstract

The distal 2/3 of the opossum esophagus contains only smooth muscle. Manometry shows that the most distal 1-2 cm is the lower esophageal sphincter. We used a variety of agonists to seek differences between circular muscle from the sphincteric segment and more rostral levels. Isometric contractions of strips from the distal 6 cm were recorded in vitro in response to acetylcholine, carbachol, methacholine, nicotine. DMPP, norepinephrine, norepinephrine with propranolol, barium, atropine, and potassium. Significant differences in threshold concentration occurred for all drugs except barium, atropine, and potassium, the more distal strips being more sensitive. The gradient of threshold was much steeper for norepinephrine than for the other drugs. Maximal responses did not differ among levels for the choline esters or ganglionic stimulants, but showed proximal diminution for norepinephrine. These differences in threshold concentration could represent differences in distribution density of drug receptor sites, differences in affinity of receptors for the agonists, differences in rates of uptake of agonists, or differences in rates of enzymatic hydrolysis; or they may have no common basis. The sphincter is defined, at least in part, in the esophageal wall rather than in the central nervous system. The greater magnitude of the difference in sensitivity to norepinephrine than for the other agents suggests that the adrenergic innervation is important in defining the lower esophageal sphincter.