Response of the Upper Esophageal Sphincter to Esophageal Distension Is Affected by Posture, Velocity, Volume, and Composition of the Infusate

被引:28
作者
Babaei, Arash
Dua, Kulwinder
Naini, Sohrab Rahimi
Lee, Justin
Katib, Omar
Yan, Ke [2 ]
Hoffmann, Raymond [2 ]
Shaker, Reza [1 ]
机构
[1] Med Coll Wisconsin, Div Gastroenterol & Hepatol, Dept Med, Milwaukee, WI 53226 USA
[2] Med Coll Wisconsin, Dept Pediat, Milwaukee, WI 53226 USA
基金
美国国家卫生研究院;
关键词
Esophagus; Stomach; Airway; GERD; CONTRACTILE REFLEX; MOTOR-RESPONSES; GASTROESOPHAGEAL-REFLUX; AIRWAY PROTECTION; AFFERENT-FIBERS; CLOSURE REFLEX; ACID; RELAXATION; PERISTALSIS; DISTENTION;
D O I
10.1053/j.gastro.2012.01.006
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
BACKGROUND & AIMS: Studies of the pressure response of the upper esophageal sphincter (UES) to simulated or spontaneous gastroesophageal reflux have shown conflicting results. These discrepancies could result from uncontrolled influence of variables such as posture, volume, and velocity of distension. We characterized in humans the effects of these variables on UES pressure response to esophageal distension. METHODS: We studied 12 healthy volunteers (average, 27 +/- 5 years old; 6 male) using concurrent esophageal infusion and high-resolution manometry to determine UES, lower esophageal sphincter, and intraesophageal pressure values. Reflux events were simulated by distal esophageal injections of room temperature air and water (5, 10, 20, and 50 mL) in individuals in 3 positions (upright, supine, and semisupine). Frequencies of various UES responses were compared using chi(2) analysis. Multinomial logistical regression analysis was used to identify factors that determine the UES response. RESULTS: UES contraction and relaxation were the overriding responses to esophageal water and air distension, respectively, in a volume-dependent fashion (P < .001). Water-induced UES contraction and air-induced UES relaxation were the predominant responses among individuals in supine and upright positions, respectively (P < .001). The prevalence of their respective predominant response significantly decreased in the opposite position. Proximal esophageal dp/dt significantly and independently differentiated the UES response to infusion with water or air. CONCLUSIONS: The UES response to esophageal distension is affected by combined effects of posture (spatial orientation of the esophagus), physical properties, and volume of refluxate, as well as the magnitude and rate of increase in intraesophageal pressure. The UES response to esophageal distension can be predicted using a model that incorporates these factors.
引用
收藏
页码:734 / U146
页数:17
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