Electrical and mechanical activity in the human lower esophageal sphincter during diaphragmatic contraction.
AUTOR(ES)
Mittal, R K
RESUMO
To determine the effect of contraction of the diaphragm on the lower esophageal sphincter (LES) pressure, we studied eight healthy volunteers during spontaneous breathing, maximal inspiration, and graded inspiratory efforts against a closed airway (Muller's maneuver). Electrical activity of the crural diaphragm (DEMG) was recorded from bipolar esophageal electrodes, transdiaphragmatic pressure (Pdi) was calculated as the difference between gastric and esophageal pressures, and LES pressure was recorded using a sleeve device. During spontaneous breathing, phasic inspiratory DEMG was accompanied by phasic increases in Pdi and LES pressure. With maximal inspiration, DEMG increased 15-20-fold compared with spontaneous inspiration, and LES pressure rose from an end-expiratory pressure of 21 to 90 mmHg. Similar values were obtained during maximal Muller's maneuvers. LES pressure fell promptly when the diaphragm relaxed. Graded Muller's maneuver resulted in proportional increases in the Pdi, LES pressure, and DEMG. The LES pressure was always greater than Pdi and correlated with it in a linear fashion (P less than 0.001). We conclude that the contraction of the diaphragm exerts a sphincteric action at the LES, and that this effect is an important component of the antireflux barrier.
ACESSO AO ARTIGO
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=329647Documentos Relacionados
- Mechanics of Sphincter Action. STUDIES ON THE LOWER ESOPHAGEAL SPHINCTER
- Pharmacologic identification of the lower esophageal sphincter
- Pressure tension, and force of closure of the human lower esophageal sphincter and esophagus.
- Hormonal regulation of human lower esophageal sphincter competence: interaction of gastrin and secretin
- Mechanism of stretch-activated excitatory and inhibitory responses in the lower esophageal sphincter