Abstract
The preparatory accommodation response of lower esophageal sphincter (LES) before swallowing is one of the mechanisms involved in LES relaxation during wet swallows, however, the physiological and/or pathological roles of LES accommodation remain to be determined in humans. To address this problem, we conducted a prospective observational study of 38 patients with normal high-resolution manometry (HRM) and 23 patients with idiopathic esophagogastric junction outflow obstruction (EGJOO) to assess dry and wet swallows. The LES accommodation measurement was proposed for practical use in evaluating the LES accommodation response. Although swallow-induced LES relaxation was observed in both dry and wet swallows, LES accommodation (6.4, 3.1–11.1 mmHg) was only observed in wet swallows. The extent of LES accommodation was impaired in idiopathic EGJOO (0.6, − 0.6–6 mmHg), and the LES accommodation measurement of patients with idiopathic EGJOO (36.8, 29.5–44.3 mmHg) was significantly higher in comparison to those with normal HRM (23.8, 18–28.6 mmHg). Successful LES relaxation in wet swallowing can be achieved by LES accommodation in combination with swallow-induced LES relaxation. Impaired LES accommodation is characteristic of idiopathic EGJOO. In addition to the IRP value, the LES accommodation measurement may be useful for evaluating the LES relaxation function in clinical practice.
Highlights
The preparatory accommodation response of lower esophageal sphincter (LES) before swallowing is one of the mechanisms involved in LES relaxation during wet swallows, the physiological and/or pathological roles of LES accommodation remain to be determined in humans
And sufficient LES relaxation is indispensable for maintaining the esophageal motility function responsible for the esophageal phase of swallowing
Swallow-induced LES relaxation induced by the swallowing action itself plays a main role in LES relaxation during meal intake[1]
Summary
The preparatory accommodation response of lower esophageal sphincter (LES) before swallowing is one of the mechanisms involved in LES relaxation during wet swallows, the physiological and/or pathological roles of LES accommodation remain to be determined in humans. In addition to this response, LES relaxation is caused by the physical stimulation of oral cavity and/ or pharynx by liquid and food before the swallowing action, which is termed pharyngeal water stimulation (PWS)-induced LES r elaxation[2] Since this PWS-induced LES relaxation appears before the swallowing action, it can be considered the LES’s accommodation of the preparatory response for swallow-induced LES relaxation. The smooth muscles of both the LES and proximal stomach are characterized by tonic contractility where the smooth muscles maintain a certain basal tone at rest and relax upon stimulation of ingested food during eating It remains to be determined how the LES accommodation response, including receptive LES relaxation, contributes to successful LES relaxation during eating
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