Response of lower esophageal sphincter pressure to beef soup or AOC-tetrapeptide stimulation in esophagitis

In this study is intended a measurement of the pressure of the lower esophageal sphincter (LES) in resting state and after various stimuli such as beef soup and AOC-tetrapeptide in cases of healthy subjects and various diseases by means of an infused open-tip method. The following results were obtained: In the cases of esophagitis, the resting LES pressure is lower than in the cases of healthy subjects and after stimulation by beef soup or tetrapeptide the LES pressure is less elevated. Based on these observations, we concluded that there are some factors other than gastrin which make the LES pressure in the cases of esophagitis lower than in controls.

Lower esophageal sphincter in reflux esophagitis

Lower esophageal sphincter pressure (LESP) was studied by intraluminal perfusion-manometry in the resting state and after graded intravenous doses of pentagastrin in 12 healthy subjects and 27 patients with reflux esophagitis. These patients were classified as having ulcerative (11) or non-ulcerative esophagitis (16) by histological examination and endoscopic appearance of the inflamed mucosa. The length of the LES was similar in patients and controls. A correlation was found between the magnitude of mean basal end-expiratory (mbe) LESP reduction and the grade of esophageal mucosa inflammation. The most reduced mbe LESP value was shown in patients with ulcerative esophagitis. It was significantly different from that of patients with non-ulcerative esophagitis (t = 3.37, p less than 0.01). Both values were significantly reduced from that of the controls (t larger than or equal to 0.0125). The responsiveness of the LES to intravenous pentagastrin was quantitatively reduced throughout the whole range of the dose-response curve in patients with ulcerative esophagitis, whereas patients with non-ulcerative esophagitis only differed in the maximum mbe pressure value from the controls. Four patients showed a paradoxical pressure decrease to intravenous pentagastrin, resulting in a LESP reduction to 8% of the mbe LESP. Intravenous secretin or CCK led to a similar reaction of the LES in these patients.

Effects of metiamide on the human stomach

1. The effect of metiamide on gastric acidity in man has been studied. Solutions of hydrochloric acid or glucose were instilled into the stomach and the subsequent rates of gastric secretion and emptying, and the disappearance of acid within the stomach, were measured. 2. Metiamide inhibited the gastric secretory response to the instilled acid and glucose solutions but did not change the overall pattern of emptying of the instilled solutions. 3. During administration of metiamide, there was a net loss of acid from within the gastric lumen. The rate of disappearance of acid from the instilled acid solution was small and not sufficient in magnitude to account for the metiamide-evoked decrease in the concentration of acid secreted in response to pentagastrin. 4. We conclude that metiamide does not inhibit gastric secretion by altering the 'barrier' function of the gastric mucosa.

Pressure tension, and force of closure of the human lower esophageal sphincter and esophagus

The mechanical characteristics of the circular muscle of the human lower esophageal sphincter and esophagus were studied in subjects with competent and incompetent sphincters. Pressure-diameter curves were constructed by producing various degrees of circumferential stretch with pressure-measuring probes of increasing diameter. The circumferential membrane tension (force of closure) and the circumferential stress (muscle tension) of the circular muscle layer were also calculated from these data. The pressure-diameter curves of competent and incompetent sphincters were different in magnitude and shape. Incompetent sphincters had lower pressures at all diameters, with pressure gradually increasing with larger probe diameter. In contrast for competent sphincters the pressure was highest near closure, with an initial decline and then an increase in pressure with increasing probe diameter. Both shape and magnitude of pressure-diameter curves of competent and incompetent sphincters were interchangeable when manipulated by pharmacologic agents. Urecholine increased the pressures and changed the incompetent pressure-diameter curve to the levels of the competent sphincter; conversely. Pro-Banthine decreased pressures and changed the shape of the competent pressure-diameter curve to the levels of the incompetent sphincter. Force of closure and circular muscle tension curves of competent and incompetent sphincters were similar in shape but were higher at all diameters for competent sphincters. Force of closure and circular muscle tension increased with larger probe diameter. However, the diameter of optimal tension development was larger than the largest probe used and certainly far from closure. Fundoplication increased the magnitude and changed the shape of the incompetent pressure-diameter curve to one similar to a competent curve. This pressure change was associated with an increase in the force of closure, suggesting that fundopliation modified the length-force of closure characteristics of the incompetent spincter.

Parietal cell vagotomy

In a series of 100 consecutive patients who had parietal cell vagotomy performed, no drainage procedure was performed in 56 while 44 were drained. Dumping was significantly less in those who were not drained. All patients were tested for adequacy of vagotomy and for function of the nerve of Latarget at operation. Four patients have had further operations, two for proven recurrent ulcers. Parietal cell vagotomy has given excellent clinical results in this group of patients.

Experimental esophagitis in cats impairs lower esophageal sphincter pressure

We studied the effect of esophageal inflammation on lower esophageal sphincter (LES) pressure in cats by measuring LES pressure and taking mucosal biopsies before and after the development of experimental esophagitis, as well as after a 3 1/2-week recovery period. Perfusion of the esophagus with 0.1 N HCl for either 1 hr or 1/2 hr per day for 4 days produced inflammatory changes by mucosal biopsy and was associated with a marked decline in LES pressure. Upon resolution of the inflammation, LES pressure returned to normal. Biopsies were normal in control groups which underwent either esophageal perfusion with distilled water or intragastric perfusion with acid, 1 hr per day for 4 days, and LES pressures in these groups remained unchanged from pre-perfusion values. These studies indicate that lower esophageal inflammation per se adversely affects LES pressure in cats, and that experimental esophagitis may be a useful model for the study of LES function and its relation to esophageal inflammation.

Upper oesophageal sphincter yield pressure in normal subjects and in patients with gastro-oesophageal reflux

Stanciu, C. and Bennett, J. R. (1974).Thorax, 29, 459-462. Upper oesophageal sphincter yield pressure in normal subjects and in patients with gastro-oesophageal reflux. Upper oesophageal sphincter yield pressure was measured in 26 normal subjects and in 69 patients with gastro-oesophageal reflux, using a system of continuously perfused catheters. There was no significant difference between the two groups. Perfusion of the oesophagus with hydrochloric acid produced no change in sphincter pressure. The resting sphincter pressure was not related to the degree of oesophagitis nor to the severity of reflux as measured by 15-hour pH recordings. There were significant differences in sphincter pressure recorded by the three catheters either when their orifices were set 5 cm apart longitudinally or when they were at the same level, equidistant around the circumference of a circle. This indicates that spatial orientation of catheter tips influences the pressure recorded from a sphincter.

Oesophageal reflux and gastric secretion

In the study to be described confirmation of the findings of Giles, Clark, and Buchan (1968) that the presence of acid in the lower oesophagus may stimulate gastric secretion has been sought. Also the influence of hiatal repair on the response to acid has been examined. The presence of acid in the lower oesophagus stimulates gastric secretion in man. The response to acid perfusion is greater in symptomatic hiatus hernia patients than in controls. Basal and perfusion outputs are lower in hiatus hernia patients with oesophagitis than in those without inflammatory change. Hiatal repair diminishes the gastric response in both groups; this effect is particularly marked in patients with oesophagitis.

The value of simple tests for peristaltic activity in hiatus hernia

A study has been made of oesophageal peristaltic activity as viewed at barium swallows, in an effort to see whether this is helpful in assessing the type and degree of oesophageal lesions associated with hiatus hernia. It has not been possible to establish a clinical usefulness from such testing as the frequency with which peristaltic upset occurs is too marginal.