ABSTRACT
BACKGROUND/AIMS: Beta-adrenoceptor is considered to be an important modulator of smooth muscle function. It is widely present in the mammalian gastrointestinal tract and nervous system. The aim of this study was to explore the expression of 1-adrenoceptors (ß1-AR, ß2-AR, ß3-AR) in sling fibers and clasp fibers from human lower esophageal sphincter (LES). METHODOLOGY: Sling and clasp fibers from the LES were obtained from patients undergoing esophagogastrectomy; circular muscle strips from the esophagus and stomach were used as controls. Reverse transcription-polymerase chain reaction and western blotting were used to determine the expression of the three subtypes of ß-adrenoceptors. RESULTS: Messenger RNA and protein for three subtypes of ß-adrenoceptors were all identified in the sling and clasp fibers of the LES. Expression was highest for ß3-AR, then ß1-AR and ß2-AR in decreasing levels. CONCLUSIONS: ß1-AR, ß2-AR, ß3-AR can be detected in human lower esophageal sphincter and contribute to LES function.
Subject(s)
Esophageal Sphincter, Lower/chemistry , Receptors, Adrenergic, beta/analysis , Aged , Blotting, Western , Esophageal Sphincter, Lower/physiology , Female , Humans , Male , Middle Aged , RNA, Messenger/analysis , Receptors, Adrenergic, beta/genetics , Receptors, Adrenergic, beta-1/analysis , Receptors, Adrenergic, beta-2/analysis , Receptors, Adrenergic, beta-3/analysis , Reverse Transcriptase Polymerase Chain ReactionABSTRACT
Manometric location of the lower esophageal sphincter (LES) has been mandatory before esophageal pH monitoring, despite costs and discomfort related with esophageal manometry. The aims of the study were: (i) to map the pH of the gastroesophageal junction (GEJ) to determine a pH turning point (PTP) and its relation with LES; and (ii) to test the feasibility of this technique to orientate esophageal pH monitoring. We studied 310 adult patients who underwent esophageal manometry and pH monitoring off acid-suppressive therapy. GEJ pH mapping was carried out by step-pulling the pH sensor from 5 cm below to 5 cm above LES, and a PTP was determined when pH changed from below to above 4, in centimeters from the nostril. Thirty-six patients referred only for pH monitoring were studied with pH sensor placed at 5 cm above the PTP. Out of 310 patients, a PTP was found in 293 (94.5%): inside LES in 86.3%, into the stomach in 8.2% and in the esophageal body in 5.5% of patients. The median distance between PTP and place where pH sensor monitored reflux was 8 cm. Among 36 patients who performed pH monitoring without LES manometry, there was no gastric monitoring during reflux testing. In adult patients investigated off acid suppressive therapy, GEJ pH mapping with reflux monitoring 5 cm above the PTP can be an alternative technique to perform esophageal pH monitoring when LES manometry is not available. Additional studies are needed before the widespread use of GEJ pH mapping in the clinical practice.
Subject(s)
Esophageal pH Monitoring/methods , Esophagogastric Junction/chemistry , Adult , Esophageal Sphincter, Lower/anatomy & histology , Esophageal Sphincter, Lower/chemistry , Esophagogastric Junction/anatomy & histology , Female , Gastric Acidity Determination , Gastroesophageal Reflux/physiopathology , Humans , Hydrogen-Ion Concentration , Male , Manometry/methods , Middle Aged , Reproducibility of ResultsABSTRACT
Diffuse esophageal spasm (DES) has been reported as a potential cause of dysphagia or chest pain; however, the patho-physiology of DES is unclear. The aim of this study was to examine the manometric correlates of dysphagia and chest pain in this patient population. All patients undergoing manometry at our institution are entered into a prospectively maintained database. After institutional review board approval, the database was queried to identify patients meeting criteria for DES (≥20% simultaneous waves with greater than 30 mm Hg pressure in the distal esophagus). The patient-reported symptoms and manometric data, along with the results of a 24-hour pH study (if done), were extracted for further analysis. Out of 4923 patients, 240 (4.9%) met the manometric criteria for DES. Of these, 217 patients had complete manometry data along with at least one reported symptom. Of the patients with DES, 159 (73.3%) had dysphagia or chest pain as a reported symptom. Patients reporting either dysphagia or chest pain had significantly higher lower esophageal sphincter (LES) pressure than patients without these symptoms (P= 0.007). Significant association was noted between reported dysphagia and percentage of simultaneous waves. Chest pain did not correlate with percent of simultaneous waves, mean amplitude of peristalsis, or 24-hour pH score. The origin of reported chest pain in patients with DES is not clear but may be related to higher LES pressure. Simultaneous waves were associated with reported dysphagia. Using current diagnostic criteria, the term DES has no clinical relevance.
