Esophageal Peristaltic Contractions Research Articles

Journey into the Esophageal Complications: Decoding Systemic Sclerosis with Cutting-Edge Endoscopy, Manometry, and Ambulatory pH-Study.

Systemic Sclerosis (SSc) is a rare connective tissue disorder characterized by autoimmunity, fibrosis, and vasculopathy that affects the skin and internal organs, including the gastrointestinal tract, particularly the esophagus. This article highlights the characteristics and clinical symptoms of esophageal involvement in patients with SSc. This study was conducted between November 2022 to August 2023, including 26 already diagnosed cases of SSc in the Department of Rheumatology and Rehabilitation and Kurdistan Center for Gastroenterology and Hepatology-Sulaymaniyah, Iraq. Esophageal involvement was investigated using esophageal manometry, esophagogastroduodenoscopy (EGD), and 24-hour impedance-pH monitoring. Females were significantly predominant (P = 0.019) regarding the symptoms; 76.9% of the patients had heart burn, 76.9% dysphagia, 73.1% water brush, and 69.2% regurgitation. In total, 69.2% of the patients showed erosive gastrointestinal reflux disease (GERD) on EGD, 76.9% had decreased lower esophageal sphincter pressure (DLESP) and decreased distal esophageal peristaltic contractions (DDEPC) on esophageal manometry, and 84.6% had reflux on pH monitoring. Raynaud's phenomenon is the most common and typically the earliest clinical manifestation of SSc. The presence of erosive GERD was found to significantly increase the risk of developing dysphagia (B = 4.725, P = 0.014, OR = 3.482) and regurgitation (B = 3.521, P = 0.006, OR = 4.030). It is crucial to take gender-specific considerations into account when diagnosing and managing esophageal complications in patients with systemic sclerosis (SSc). Additionally, employing various diagnostic assessments to detect esophageal involvement during SSc is essential. Erosive GERD has been identified as a risk factor that contributes to the development of dysphagia and regurgitation in individuals with SSc.

Distension-contraction profile of peristalsis in patients with nutcracker esophagus.

High amplitude peristaltic esophageal contractions, that is, nutcracker esophagus, were originally described in association with "angina-like pain" of esophageal origin. However, significant number of nutcracker patients also suffer from dysphagia. High-resolution esophageal manometry (HRM) assesses only the contraction phase of peristalsis. The degree of esophageal distension during peristalsis is a surrogate of relaxation and can be measured from the intraluminal esophageal impedance measurements. Determine the amplitude of distension and temporal relationship between distension and contraction during swallow-induced peristalsis in nutcracker patients. HRM impedance (HRMZ) studies were performed and analyzed in 24 nutcracker and 30 normal subjects in the Trendelenburg position. A custom-built software calculated the numerical data of the amplitudes of distension and contraction, the area under the curve (AUC) of distension and contraction, and the temporal relationship between distension and contraction. In normal subjects, the distension peaks similar to contraction traverse sequentially the esophagus. The amplitude of contraction is greater in the nutcracker esophagus but the amplitude of distension and area under the curve of distension are smaller in patients compared to controls. Distension peaks are aligned closely with contraction in normal subjects, but in patients, the bolus travels faster to the distal esophagus, resulting in a smaller time interval between the onset of swallow and distension peak. Receiver operative characteristics (ROC) curve reveals high sensitivity and specificity of the above parameters in patients. Abnormalities in the distension phase of peristalsis are a possible mechanism of dysphagia in patients with nutcracker esophagus.

Mechanisms of Esophageal and Gastric Transit Following Sleeve Gastrectomy.

Sleeve gastrectomy (SG) patients have substantially altered anatomy. The mechanism of rapid gastric emptying and the role of esophageal contractile function in esophago-gastric transit has not been defined. We aimed to determine the mechanisms of esophago-gastric transit and role of esophageal function following sleeve gastrectomy. Prospective study of twenty-six asymptomatic participants post SG underwent nuclear scintigraphy and high-resolution manometry. Fourteen had semi-solid stress barium to model the emptying process. Concurrent video fluoroscopy and manometry were performed on 7 participants. Demographic data are as follows: age 45.3 ± 15.0years, 73.1% female, excess weight loss 62.2 ± 28.1% at 8months. Scintigraphy showed rapid gastric emptying (24.4 ± 11.4 vs. 75.80 ± 45.19min in control, p < 0.001) with 35.24 ± 17.12% of bolus transited into small bowel on initial frame. Triggered deglutitive reflux was common (54.4% vs. 18.2%, p = 0.017). Stress barium delineated separate vertical and antral gastric compartments with cyclical emptying of 8 stages, including reflux-induced repeated esophageal peristalsis. During manometry, ramping effects were noted, with sequential swallows producing sustained isobaric pressurizations in proximal stomach (33.6 ± 29.5mmHg). Video fluoroscopy showed individual esophageal peristalsis generating pressurizations at 5.0 ± 1.4cm below lower esophageal sphincter (LES), at amplitude of 31.6 ± 13.1mmHg, associated with intragastric transit. Pressurizations were sustained for 17.3 ± 8.2s, similar to the prolonged LES contraction (18.5 ± 9.0s, p = 0.355). Repeated esophageal peristaltic contractions induced isobaric pressurization of proximal stomach, thus providing the drive to pressurize and empty the vertical compartment of the gastric sleeve. Transit following SG appeared to be esophageal-mediated and followed a distinct cycle with strong associations with reflux.

Effects of GABA-B agonist baclofen on esophageal motility: Studies using high-resolution manometry.

Baclofen inhibits transient lower esophageal sphincter (LES) relaxation. This study aimed to investigate the effect of baclofen on esophageal peristaltic function and contraction reserve in healthy adults using high-resolution manometry (HRM). Fifteen subjects underwent HRM with ten water swallows and five multiple rapid swallows (MRS) 90minutes after oral intake of either baclofen or placebo on separate days at least 1week apart. HRM parameters assessed included esophagogastric junction contractile integral (EGJ-CI), resting LES pressure, 4-second integrated relaxation pressure (IRP-4s), distal contractile integral (DCI), distal latency, peristaltic breaks, resting upper esophageal sphincter (UES) pressure, and contractile response to MRS. Baclofen significantly increased EGJ-CI (P=.007), IRP-4s (P=.003), and LES pressure (P=.004). UES pressure, latency, and DCI were similar between baclofen and placebo (P=.87, P=.84, and P=.54, respectively). There was no difference in contractile response and peristaltic augmentation following MRS between baclofen and placebo (93% vs 100%, P=.30; 53% vs. 73%, P=.26, respectively). Baclofen increases resting LES pressure and EGJ barrier function, but has no effect on primary peristalsis or contraction reserve.

WATER INGESTION DYNAMICS IN PATIENTS WITH ACHALASIA: INFLUENCE OF SEX AND AGE.

Achalasia is a disease that affects esophageal bolus transit due to the absence of esophageal peristaltic contractions and impaired or absent relaxation of the lower esophageal sphincter. The objective of this investigation was: a) to evaluate the dynamics of water ingestion in patients with achalasia, idiopathic or caused by Chagas' disease; b) to evaluate the influence of sex and age on water ingestion dynamics. The investigation was conducted with 79 patients with achalasia (27 idiopathic and 52 Chagas' disease) and 91 healthy volunteers, all evaluated by the water-drinking test. The individuals drank, in triplicate, 50 mL of water without interruption. The time and the number of swallows for this task were counted. We also measured: (a) inter-swallow interval - the time to complete the task, divided by the number of swallows during the task; (b) swallowing rate - volume drunk divided by the time; (c) volume per swallow - volume drunk divided by the number of swallows. Patients with achalasia took longer to ingest all the volume (mean 12.2 seconds) than healthy controls (mean 5.4 seconds), had greater number of swallows, longer interval between swallows, lower swallowing rate (5.2 mL/s vs 10.9 mL/s in controls) and lower volume per swallow (9.1 mL vs 14.4 mL in controls, P<0.01). Among healthy volunteers, women had a shorter interval between swallows and lower volume per swallow compared with men, and in the achalasia group, women had a longer interval between swallows and lower ingestion rate. No difference in the drinking test results was found between younger and older subjects in achalasia or control group. Also, no differences were observed between patients with Chagas' disease and those with idiopathic achalasia, or between patients with increased and normal esophageal diameter. Patients with achalasia have difficulty in ingesting water, taking a longer time to complete the task, which is influenced by sex but not by age or severity of the disease.

The Effect of Acute Stress on Esophageal Motility and Gastroesophageal Reflux in Healthy Humans.

Background/AimsLittle research has been done to evaluate the effect of stress in exacerbating the symptoms associated with gastroesophageal reflux (GER). We aimed to investigate the effect of acute stress on esophageal motility and GER parameters in healthy volunteers.MethodsA total of 10 (M:F = 8:2, median age 34 years-old) healthy volunteers without any recurrent gastrointestinal symptoms participated in this study. They underwent esophageal high-resolution manometry with 10 wet swallows (Experiment I) and esophageal impedance-pH monitoring (Experiment II) in the basal period and in the stress period. In the stress period, either real stress or sham stress was given in a randomized cross-over design. The stress scores, symptom severity, and pulse rates were measured.ResultsThe stress scores and the severity of nausea were significantly greater under real stress, compared with sham stress. The percentages of weak, failed, rapid, premature, and hyper-contractile contractions were not significantly altered during real stress and during sham stress, compared with the basal period. The median resting pressure of the lower esophageal sphincter and distal contractile integral of esophageal contractions did not differ in the stress period, compared with the basal period. Contractile front velocity and distal latency of esophageal peristaltic contractions were significantly changed during real stress, which was not observed during sham stress. GER parameters were not significantly altered during real stress and during sham stress.ConclusionAlthough acute auditory and visual stress seems to affect esophageal body motility, it does not induce significant motor abnormalities or increase GER in healthy humans.

The Pharyngoesophageal Segment After Total Laryngectomy.

The aim of the present study was to characterize the pharyngoesophageal segment in laryngectomees who rated themselves as functional tracheoesophageal speakers. Voice perceptual assessment, high-resolution videomanometry of swallowing and phonation, and high-speed camera recording during phonation provided information about the anatomy and function of the pharyngoesophageal segment. Fourteen patients were included in the study. The voice assessments presented high intra/inter-listener reliability. We found a significant correlation between roughness and poor voice quality, hyperfunction and poor intelligibility, and poor voice quality, long time since the operation, and old age. High-resolution videomanometry during phonation revealed decreasing mean pressures from the distal esophagus to the pharynx and confirmed low resting pressures at the pharyngoesophageal segment and low esophageal peristaltic contraction pressures after laryngectomy in comparison to normal subjects. The neoglottis shape was mainly circular and presented a strong mucosal wave in most of the patients on the high-speed camera recording. Perceptual voice assessment and high-speed camera recordings provided baseline information about voice characteristics and vibration regularity of the neoglottis. Additionally, the quantitative measures obtained with high-resolution videomanometry may have clinical applicability as reference data in voice rehabilitation after total laryngectomy.

Frequency of Jackhammer Esophagus as the Extreme Phenotypes of Esophageal Hypercontractility Based on the New Chicago Classification.

Jackhammer Esophagus is defined as intact esophageal peristaltic contractions with extremely elevated amplitudes. We conducted a retrospective study to identify the frequency of esophageal hypercontractility and the clinical characteristics of Jackhammer Esophagus. Charts for the patients referred for manometric study at a tertiary-care motility center were reviewed. Data were collected utilizing the new Chicago classification criteria for Jackhammer Esophagus. Concomitant clinical variables were also explored. Eight patients were identified with Jackhammer Esophagus from a total of 205 (127 female/77 male) patients referred for high-resolution esophageal manometry. Jackhammer patients had an average distal contractile integral (DCI) of 9061 mmHg/ sec/ cm and median maximal DCI of 16,433 mmHg/ sec/ cm. The greatest DCI from 15 swallows was 28,875 mmHg/ sec/ cm. Hypercontractility was associated with multipeaked contractions in every Jackhammer patient. The mean lower esophageal sphincter (LES) pressure was 41 mm Hg with 4 patients having a hypertensive pressure of >40 mm Hg. Three of the 8 (37.5%) Jackhammer group had incomplete LES relaxation by integrated relaxation pressure criteria (>15 mm Hg residual pressure). Dysphagia (8/8) was the dominant indication for the manometric study, whereas the clinical background setting was gastroesophageal reflux disease (4/8) and hiatal hernia (1/8). Treatments included smooth muscle relaxation, antireflux regimens, and pneumatic dilation of the LES. Jackhammer Esophagus, an extreme manometric phenotype, was identified in 4.0% of patients referred to a University Motility Center. The patients with these esophageal hypercontractility states present mainly with dysphagia. A subgroup of Jackhammer did have accompanying incomplete LES relaxation and responded to targeted therapy with pneumatic dilatation.

Effects of Metoclopramide on Esophageal Motor Activity and Esophagogastric Junction Compliance in Healthy Volunteers.

Background/AimsProkinetic drugs such as metoclopramide are frequently used as second-line therapy for patients with gastroesophageal reflux disease. However, their beneficial effects remain unclear. Esophageal motor activities and compliance of the esophagogastric junction (EGJ) are important for prevention of gastroesophageal reflux. Although metoclopramide has been reported to increase lower esophageal sphincter (LES) pressure, its effects on EGJ compliance have not been evaluated. In the present study, we investigated the effects of metoclopramide on esophageal motor activities and EGJ compliance.MethodsNine healthy male volunteers without abdominal symptoms were enrolled. Peristaltic esophageal contractions and LES pressure were examined using high-resolution esophageal manometry, while EGJ compliance was evaluated with an endoluminal functional lumen-imaging probe. After obtaining baseline values for esophageal motor activities and EGJ compliance, metoclopramide (10 mg) was intravenously administered, then all measurements were repeated at 15 minutes after administration in each subject.ResultsFollowing administration of metoclopramide, mean resting LES pressure was significantly increased as compared with the baseline (13.7 ± 9.2 vs 26.7 ± 8.8 mmHg, P < 0.05). In addition, metoclopramide significantly augmented peristaltic contractions, especially in the distal esophageal segment (P < 0.05). On the other hand, distensibility index did not change after administration (4.5 ± 0.5 vs 4.1 ± 0.5 mm2/mmHg), suggesting no significant effect of metoclopramide on EGJ compliance.ConclusionsMetoclopramide augmented esophageal contractions without changing EGJ compliance in healthy adults.

Low esophageal mucosal blood flow in patients with nutcracker esophagus

Nutcracker esophagus (NE) is characterized by high-amplitude peristaltic esophageal contractions, and these patients often present with symptoms of "angina-like" or noncardiac chest pain. Tissue ischemia is a known cause of visceral pain, and the goal of our present study was to determine whether esophageal wall blood perfusion (EWBP) is reduced in patients with NE. Fourteen normal subjects (mean age 51 yr, 11 men) and 12 patients (mean age 53 yr, 9 men) with NE and noncardiac chest pain were investigated. The EWBP was measured continuously using a custom-designed laser Doppler probe tethered to a Bravo capsule, which anchored it to the esophageal wall. The baseline EWBP in normal subjects was 651 ± 27 perfusion units. In patients with NE, the baseline EWBP was significantly lower than in the normal subjects (451 ± 32 perfusion units). The EWBP decreased after injection of edrophonium (which increases muscle contractions) and increased following sublingual nitroglycerin administration (which relaxes muscle) in normal subjects, as well as in NE patients. Spontaneous pain events during the recording period were often associated with drops in the EWBP. We propose that low EWBP leads to hypoxia of the esophageal tissue, which may be a mechanism of esophageal pain in patients with NE.

Frequency of Jackhammer Esophagus as the Extreme Phenotypes of Esophageal Hypercontractility Based on the New Chicago Classification

Introduction: Jackhammer Esophagus defined as intact esophageal peristaltic contractions with extremely elevated amplitudes. We conducted a retrospective study to identify the frequency of esophageal hypercontractility and the clinical characteristics of Jackhammer Esophagus. Methods: Charts for the patients referred for manometric study at a tertiary-care motility center were reviewed. Data were collected utilizing the new Chicago classification criteria for Jackhammer Esophagus. Concomitant clinical variables were also explored. Results: From a total of 205 patients (127 F/77 M), 8 patients met criteria for Jackhammer Esophagus from a total of. Jackhammer patients had an average distal contractile integral (DCI) of 9,061 mm Hg-sec-cm and median maximal DCI of 16,433 mm Hg-sec-cm. The greatest DCI from 15 swallows was 28,875 mm Hg-sec-cm. Hypercontractility was associated with multipeaked contractions in every Jackhammer patient. The mean lower esophageal sphincter (LES) pressure was 41 mmHg (4 patients > 40). 37.5% of Jackhammer group had incomplete LES relaxation by Integrated Relaxation Pressure (IRP) criteria. Dysphagia (8/8) was the dominant indication for the manometric study, while the clinical background setting was gastroesophageal reflux disease (4/8) and hiatal hernia (1/8). Treatments included smooth muscle relaxation, anti-reflux regiments, and pneumatic dilation of the LES. Conclusion: 1) Jackhammer Esophagus, an extreme manometric phenotype, was identified in 4.0% of patients referred to a University Motility Center; 2) The patients with these esophageal hypercontractility states present mainly with dysphagia; 3) a subgroup of Jackhammer did have accompanying incomplete LES relaxation and responded to a targeted therapeutic with pneumatic dilatation.

Impaired Upper Esophageal Sphincter Reflexes in Patients With Supraesophageal Reflux Disease

Normal responses of the upper esophageal sphincter (UES) and esophageal body to liquid reflux events prevent esophagopharyngeal reflux and its complications, however, abnormal responses have not been characterized. We investigated whether patients with supraesophageal reflux disease (SERD) have impaired UES and esophageal body responses to simulated reflux events. We performed a prospective study of 25 patients with SERD (age, 19-82 y; 13 women) and complaints of regurgitation and supraesophageal manifestations of reflux. We also included 10 patients with gastroesophageal reflux disease (GERD; age, 32-60 y; 7 women) without troublesome regurgitation and supraesophageal symptoms and 24 healthy asymptomatic individuals (controls: age, 19-49 y; 13 women). UES and esophageal body pressure responses, along with luminal distribution of infusate during esophageal rapid and slow infusion of air or liquid, were monitored by concurrent high-resolution manometry and intraluminal impedance. A significantly smaller proportion of patients with SERD had UES contractile reflexes in response to slow esophageal infusion of acid than controls or patients with GERD. Only patients with SERD had abnormal UES relaxation responses to rapid distension with saline. Diminished esophageal peristaltic contractions resulted in esophageal stasis in patients with GERD or SERD. Patients with SERD and complaints of regurgitation have impaired UES and esophageal responses to simulated liquid reflux events. These patterns could predispose them to esophagopharyngeal reflux.

Per oral endoscopic myotomy (POEM) for all spastic esophageal disorders?

Per oral endoscopic myotomy (POEM) for all spastic esophageal disorders?

Evaluation of the Frequency of Nutcracker and Jackhammer Esophagus as the Extreme Phenotypes of Esophageal Hypercontractility: A Single-Center Experience

Introduction: Hypertensive esophageal peristaltic contractions are usually reported as Nutcracker Esophagus in manometry. Recently, extreme high amplitude peristalsis is defined as Jackhammer Esophagus with multipeaked contractions. We conducted a retrospective study to identify the frequency of esophageal hypercontractility in patients referred for manometry and their clinical characteristics. Methods: Charts review was conducted for patients referred for manometry at a tertiary care motility center in USA from January 2012 to April 2014. The threshold for hypercontractility was defined as a wet swallow with distal contractile integral (DCI, mmHg-s-cm)>5000, while the occurrence of at least a single contraction with DCI>8000 met the criteria for Jackhammer. The diagnosis of Nutcracker or Jackhammer Esophagus was also made based on the conclusion reached by RMC who read all studies. Concomitant clinical variables were explored. Results: A total of 179 (113 F/65 M, mean age=57 y/o) patients were referred for esophageal manometry. A total of 22 patients were identified with Nutcracker or Jackhammer Esophagus. All of them had contractile propagation and distal contractile latency within normal limit range and achalasia and distal esophageal spasm were excluded. The diagnosis of Nutcracker was made in 17 patients with an average DCI of 3419 and median maximal DCI of 5668, while the diagnosis of Jackhammer was made in 5 patients with an average DCI of 10161 and median maximal DCI of 16642. The greatest DCI value observed in any swallow was 24208. The average lower esophageal sphincter basal mean pressure was 27.8 mmHg in the Nutcracker group while 56.6 mmHg in the Jackhammer group. The mean lower esophageal sphincter residual pressure was 11.7 mmHg in the Nutcracker group and 29.9 mmHg in the Jackhammer group indicated incomplete relaxation. Hypercontractility was associated with multipeaked contractions in every Jackhammer patient. Dysphagia (17/22) was the dominant indication for the manometric study in patients with both Nutcracker and Jackhammer Esophagus including food impaction. Subsets patients had hypercontractility in the setting of reflux disease (13/22), Hiatal hernia (4/22), Chest pain (3/22). Conclusion: Jackhammer Esophagus, an extreme phenotype of hypercontractility characterized manometrically by at least a single contraction with DCI >8,000, and multipeaked contractions in 2.8% of patients referred to a tertiary center, compared to 9.5% with Nutcracker Esophagus, which has a lower DCI. The patients with these extreme phenotypes of esophageal hypercontractility present mainly with dysphagia, partly explained by incomplete relaxation of the lower esophageal sphincter, which offers one avenue for a therapeutic approach in this subset.

Tu1195 The Effect of Tadalafil on Esophageal Motor Function

Background: Recently it has been described that 5-phosphodiesterase (5-PDE) inhibitors produce esophageal smooth muscle relaxation through the increase and extension of the inhibitory activity of cGMP. Some studies have shown that sildenafil alters LES function, amplitude and velocity of esophageal peristaltic contractions but not induce gastro-oesophageal reflux. Tadalafil is a 5-PDE inhibitor that has a half-life of 18 hours and its plasma clearance can take up to 72 hours. Thus, in this study we hypothesize that tadalafil induce a sustained and prolonged effect in esophageal motor function. Objective: To evaluate the effect of a single dose of 20 mgs of tadalafil on esophageal motility and the lower esophageal sphincter in healthy volunteers and patients with spastic disorders of the esophagus. Materials and Methods: In this study, we included 10 healthy volunteers (6 men, mean age 27.5 years) and 10 patients (6 with type II achalasia, 2 with type III achalasia and 2 with hypertensive peristalsis [5 men, mean age 45 years]). At baseline, in all subjects a highresolution manometry (Given, Yoqneam, Israel) was performed. Baseline HRM included 10 swallows of 5ml of NaCl; then all subjects received 20 mgs of tadalafil (Cialis, LillyICOS, Washington, U.S.) and the catheter was left in place 2 hours. At 15, 30, 45, 60 and 120 minutes after the tadalafil dose, 5 swallows of 5 ml were performed. Blood pressure and heart rate was recorded continuously. 24 hours and 48 hours after de tadalafil dose, all subjects return to the lab to repeat HRM. We measure LES and esophageal motility function according to the Chicago II classification parameters. Results: In controls, 60 minutes after tadalafil administration a decrease in basal resting pressure of the LES was recorded (18.8 ± 4 mmHg ,p = 0.019) and this decrease was progressive at, 2 hours, 24 and 48 hours (Figure 1). The lowest point of pressure was reached after 48 hours. The pressure reduction was observed in all but one subject. The average amplitude of esophageal contraction significantly decreased in all 3 segments after 45 minutes of the administration of tadalafil, and its recovery began at 48 hours (Figure 2 p ,0.05). Similar findings were recorded in 8 of the 10 patients. In addition, 6 patients reported improvement of dysphagia at 24 and 48 hours, and in threes case this improvement lasted up to 72 hours. In all cases there were not cardiovascular effects with the administration of tadalafil. The most common side adverse effect reported was mild headache. Conclusions: Tadalafil is a 5-PDE that induce a prolonged and sustained effect on esophageal contractions, is well tolerated and it could be a promising drug in the management of esophageal motor disorders.

Effects of peroral endoscopic myotomy on esophageal dynamics in patients with esophageal achalasia

To investigate the effects of peroral endoscopic myotomy(POEM) on esophageal dynamics in patients with esophageal achalasia. From September 2011 to November 2011, 20 cases with esophageal achalasia received POEM at the Endoscopic Center in the Zhongshan Hospital of Fudan University. Pre-operation esophageal dynamics of all the patients were evaluated by high resolution manometry(HRM) system and 3 days after operation the test was repeated. Lower esophagus sphincter resting pressure(LESP), 4-second integrated relaxation pressure(4sIRP), lower esophagus sphincter relax rate(LESRR), lower esophagus sphincter length(LESL), and esophageal manometry were analyzed. After POEM, LESP decreased from(29.1±17.0) mm Hg to(14.6±4.9) mm Hg, and decrease rate was 49.8%(P<0.01). However, the decreases in LESRR and LESL were not statistically significant(P>0.05). Esophageal peristaltic contraction was absent in all the 20 patients preoperatively. After POEM, changes in the esophageal contraction were seen in 7 patients, and peristalsis was noticed but was below normal level. There were no significant changes in peristalsis in the remaining 13 patients. POEM can significantly reduce LESP and 4sIRP in patients with achalasia, but can not affect the contraction of the esophagus.

Effects of Rikkunshito (TJ-43) on Esophageal Motor Function and Gastroesophageal Reflux

Background/AimsRikkunshito (TJ-43), an herbal medicine, has been demonstrated to relieve gastroesophageal reflux symptoms. However, the effects of TJ-43 on esophageal motor functions have not been fully determined. This double-blind crossover study was performed to investigate the effects of TJ-43 on esophageal motor functions and gastroesophageal reflux.MethodsThe subjects were 10 normal male volunteers. Lower esophageal sphincter pressure and esophageal body peristaltic contractions with and without 1-week administration of TJ-43 were examined in a crossover fashion. Post-prandial gastroesophageal reflux was also determined using a multi-channel impedance pH dual monitor.ResultsTJ-43 at a standard dose of 7.5 g/day did not significantly augment esophageal peristaltic contraction pressure measured in the proximal, middle and distal segments of the esophagus, whereas increment of resting lower esophageal sphincter pressure was observed in a supine position. In addition, TJ-43 administration did not decrease post-prandial gastroesophageal acid, non-acid reflux events or accelerate esophageal clearance time.ConclusionsTJ-43 at a standard dose did not have a significant effect on esophageal motor activity or gastroesophageal reflux in healthy adults.

Normative values of the esophageal manometry and its influential factors in the healthy subjects: a multiple center study in China

Objective To establish normative values of esophageal manometry in different age groups and standard test method.Methods The values of esophageal manometry were tested in healthy subjects of 3 different age groups (Group Ⅰ: 18-39 years,Group Ⅱ: 40-59 years,Group Ⅲ:≥60 years) with pneumohydraulic capillary perfusion system.The repeatability and stability of this method in lower esophageal sphincter (LES) testing were observed. Results There were no significant differences of LES length (LESL),LES pressure (LESP) at the end of expiration,average LESP,residual pressure of LES and LES relaxation rate (LESRR) in three groups (P＞0.05).The LESP at the end of inspiration in Group Ⅰ (28.98± 1.11 ) mm Hg was significantly lower than that of Group Ⅲ (34.35±1.96) mm Hg (P＜0.05).Trandiaphragmatic pressure (Pdi) in Group Ⅰ (9.55±0.62) mm Hg was significantly lower than that of Group Ⅱ (13.05±0.76) mm Hg (P＜0.05).There were no significant differences in contraction amplitude and duration of proximal and distant esophagus in 3 groups (P＞0.05).UES pressure (UESP) of Group Ⅲ was significantly lower than that of Group Ⅰ and Ⅱ (P＜0.05).As for repeatability,the second recording of LESP in Group Ⅰ and Ⅱ were significantly higher than first recording (P＜0.05).Amplitude of distant esophageal peristaltic contraction (DEPC) of female was significantly higher than of male (P＜0.05).However,there was no significant difference in amplitude of proximal esophageal peristaltic contraction (PEPC)between femal and male (P＞0.05).Conclusions The normative values of esophageal manometry in different age groups have been obtained.The dynamic parameters of LES do not change with age.Between age 40 to 59 years old,the contraction of esophageal body is strongest.UESP decreases significantly in old people.If the subjects have enough time to adapt before test,it will help to get accurate and reliable dynamic parameters of LES. Key words: Esophageal sphincter, lower; Age factors; Esophageogastric junction; manometry; Peristalsis

The mechanism of weight loss with laparoscopic adjustable gastric banding: induction of satiety not restriction

Laparoscopic adjustable gastric banding (LAGB) has rapidly emerged as a popular bariatric procedure because of its safety, efficacy, durability and adjustability. Despite widespread use, there is limited understanding of how it induces weight loss. Previously, it has been classified as a restrictive procedure, physically limiting the patient to a small meal that subsequently slowly empties into the distal stomach. However, the tiny pouch of stomach created above the LAGB appears to be unable to accommodate even the smallest of meals. Therefore, the key mechanism has been hypothesized to be the induction of satiety via, as yet, undefined pathways. The critical question remains: what are the key physiological changes that lead to satiety and weight loss? In successful LAGB patients, a consistent intraluminal pressure at the level of the LAGB of 26.9 ± 19.8 mm Hg is observed. Studies using semi-solid swallows combined with intraluminal pressure recordings have demonstrated that semi-solid transit across the resistance of the LAGB is mediated by repeated esophageal peristaltic contractions (mean 4.5 ± 2.9) that produce episodic flow, interspersed by reflux events. Failed transit results in obstruction and regurgitation, whereas dilatation of the supraband stomach induces severe and intolerable reflux. Overall gastric emptying does not appear to be significantly altered following LAGB. Focused investigations have shown that the supraband stomach is empty of an ingested meal 1-2 min after intake ceases. Considerable progress has been made in understanding the mechanical physiological effects of the LAGB on esophageal and proximal gastric function. These have been correlated with patient outcomes and sensations. On the basis of recent data, it appears that the LAGB activates the peripheral satiety mechanism without physically restricting the meal size. Therefore, it should not be classified as a restrictive procedure. The precise mechanism of weight loss with the LAGB remains to be delineated.

Effects of mosapride on esophageal functions and gastroesophageal reflux

A substantial number of patients with gastroesophageal reflux disease show symptomatic resistance to high-dose proton pump inhibitors. In those cases, prokinetics are possible candidates for treatment. The aim of the present study was to determine whether mosapride, a prokinetic agent, stimulates esophageal functions, and prevents acidic and non-acidic gastroesophageal reflux. Normal volunteers (nine and 13 for two experiments, respectively) were enrolled. Salivary secretion, esophageal peristaltic contractions, and resting lower esophageal sphincter pressure with and without mosapride administration were recorded using a cross-over protocol. Post-prandial acidic and non-acidic reflux levels were also recorded. Mosapride at a standard dose of 15 mg/day did not stimulate salivary secretion or any esophageal motor functions. It also failed to prevent acidic and non-acidic post-prandial gastroesophageal reflux. Mosapride at 15 mg/day, a standard dose in Japan, did not change the esophageal motility and salivary secretion in healthy volunteers. Future study on a larger number of individuals with higher dose of mosapride is worthwhile.