Faculty Collaboration Database

Response of the upper esophageal sphincter to esophageal distension is affected by posture, velocity, volume, and composition of the infusate. Gastroenterology 2012 Apr;142(4):734-743.e7

Date

01/18/2012

Pubmed ID

22248662

Pubmed Central ID

PMC3327135

DOI

10.1053/j.gastro.2012.01.006

Scopus ID

2-s2.0-84862789265 (requires institutional sign-in at Scopus site)   30 Citations

Abstract

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 χ(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.

Author List

Babaei A, Dua K, Naini SR, Lee J, Katib O, Yan K, Hoffmann R, Shaker R

Authors

Kulwinder S. Dua MD Professor in the Medicine department at Medical College of Wisconsin
Reza Shaker MD Assoc Provost, Sr Assoc Dean, Ctr Dir, Chief, Prof in the Medicine department at Medical College of Wisconsin
Ke Yan PhD Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Air
Chi-Square Distribution
Esophageal Sphincter, Upper
Female
Humans
Linear Models
Logistic Models
Male
Manometry
Models, Biological
Muscle Contraction
Muscle Relaxation
Odds Ratio
Patient Positioning
Perfusion
Posture
Predictive Value of Tests
Pressure
Supine Position
Water
Wisconsin
Young Adult