Axial stretch: A novel mechanism of the lower esophageal sphincter relaxation

Swallow and esophageal distension-induced relaxations of the lower esophageal sphincter (LES) are associated with an orad movement of the LES because of a concurrent esophageal longitudinal muscle contraction. We hypothesized that the esophageal longitudinal muscle contraction induces a cranially directed mechanical stretch on the LES and therefore studied the effects of a mechanical stretch on the LES pressure. In adult opossums, a silicon tube was placed via mouth into the esophagus and laparotomy was performed. Two needles with silk sutures were passed, 90 degrees apart, through the esophageal walls and silicon tube, 2 cm above the LES. The tube was withdrawn, and one end of each of the four sutures was anchored to the esophageal wall and the other end exited through the mouth to exert graded cranially directed stretch on the LES by using pulley and weights. A cranially directed stretch caused LES relaxation, and with the cessation of stretch there was recovery of the LES pressure. The degree an d duration of LES relaxation increased with the weight and the duration of stretch, respectively. The mean LES relaxation in all animals was 77.7 +/- 4.7%. The required weight to induce maximal LES relaxation differed in animals (714 +/- 348 g). N(G)-nitro-L-arginine, a nitric oxide inhibitor, blocked the axial stretch-induced LES relaxation almost completely (from 78 to 19%). Our data support the presence of an axial stretch-activated inhibitory mechanism in the LES. The role of axial stretch in the LES relaxation induced by swallow and esophageal distension requires further investigation.     

一氧化氮：奥迪氏括约肌的重要信使物质

奥迪氏括约肌（ＳＯ）的非肾上腺素能非胆碱能（ＮＡＮＣ）神经元和和神经纤维与其它胃肠道一样也存在一氧化氮合酶（ＮＯＳ）。刺激ＳＯ神经后有ＮＯ释放,应用能直接释放ＮＯ的药物硝普钠所产生的效应同刺激ＳＯ的ＮＡＮＣ神经的效应十分相似。使用ＮＯＳ抑制剂可阻断刺激ＮＡＮＣ神经所引起舒张反应。提示ＮＯ是ＮＡＮＣ神经的抑制性递质之一。ＮＯ广泛分布于人和哺乳动物的ＳＯ,对其正常生理运动起抑制性调控作用。此外,ＮＯ可     

By-passing the sphincter of Oddi does not affect gallbladder emptying in the pig

A study of the relationship between bile secretion and nutrition in the pig requires a complete and continuous collection of the bile and its reinfusion to the animal. In most of the studies performed in different species, bile has been directly reinfused into the duodenum, leading to the exclusion of the sphincter of Oddi from the biliary pathway. It has been postulated that such an exclusion could inhibit gallbladder emptying. The aim of the present work was to study postprandial gallbladder emptying in the pig, depending on the site of bile reinfusion, i.e. the duodenum or the lower bile duct. The gallbladder bile was coloured with indocyanine green (ICG) and marker secretion was recorded after a test-meal. The results showed that after meal intake, the gallbladder emptied over a similar period of time and according to similar kinetics, whatever the site of bile reinfusion.     

Action of cholecystokinin on the dog sphincter of Oddi: influence of anti-cholinergic agents.

Effects of cholecystokinin (CCK) on bile flow through the sphincter of Oddi (SO) were studied in anaesthetized dogs. Intravenous injection of CCK (0.25, 0.5, 1 and 2 IDU/Kg) elicited a dose-dependent reduction in flow through the SO in the first minutes after CCK administration. Pirenzepine and atropine decreased significantly (P less than 0.05) by 29% and a 40% respectively the inhibitory effect induced by 1 IDU/Kg of CCK, whereas hexamethonium elicited an increase in the inhibitory effect induced by 0.5 IDU/Kg of CCK (P less than 0.05). Intravenous infusion of cummulative doses of CCK had different effects according to the dose infused. Lower doses (0.025 and 0.05 IDU/Kg/min) increased transphincteric flow, however, high doses (0.1, 0.2 and 0.4 IDU/Kg/min) were inhibitory. These finding indicated that CCK had two effects on the SO : firstly, a contractile effect, probably mediated through a direct myogenic action and neuronal release of ACh, and secondly a relaxant effect, probably mediated by stimulation of inhibitory postganglionic neurons.     

Action of gastrointestinal hormones on the myoelectric activity of the sphincter of Oddi in living rabbit

The aim of this work was to compare the action of gastrointestinal (GI) hormones on the myoelectrical activity of the sphincter of Oddi. Using an experimental design previously described, we studied the electrical activity of the sphincter of Oddi and compared the percentage variation in the number of spikes before and after injection of hormones. Increasing doses of the following hormones were injected i.v. at random: CCK, OP-CCK, caerulein, bombesin, gastrin, secretin and glucagon. CCK and caerulein (as previously found), and also bombesin, OP-CCK and gastrin increased the spikes activity of the sphincter of Oddi. Secretin had no effect and glucagon decreased this activity. There was no tachyphylaxis, but a good dose-effect relationship for each hormone. Compared on a molar basis caerulein is 8 times more effective than CCK and OP-CCK which in turn are more potent than bombesin. Gastrin acts only at pharmacological doses.     

Histamine release as the basis for morphine action on bile duct and sphincter of Oddi

We have investigated the mechanism by which morphine contracts hog bile duct and sphincter of Oddi. Morphine contraction is antagonized by naloxone, competitively on the sphincter, noncompetitively on the bile duct. Diphenhydramine at low concentration (3.4 X 10(-6)M) also antagonizes both actions of morphine. Histamine has a very potent contracting action on the sphincter and bile duct and this is antagonized by diphenhydramine. Burimamide only weakly antagonizes the actions of morphine or histamine. Compound 48/80 causes a pronounced contraction of sphincter and bile duct following which morphine effects are greatly attenuated. These results suggest that morphine-induced contraction of the sphincter of Oddi and bile duct is mediated by a two step reaction involving interaction with a specific opiate receptor leading to the release of histamine which combines with an H1 receptor to produce the effect.     

中缝隐核对兔奥迪氏括约肌肌电活动的影响

实验用电生理学和微量注射法观察了兔中缝隐核（NRO）对奥迪氏括约肌肌电活动的影响,动物禁食但自由饭水,18－24h手用乌拉坦（1.0g/kg)静脉麻醉,用双极康铜丝电极引导奥迪氏括约肌肌电,发现NRO内微注射谷氨酸（340mmol/L,0.4ul)可使奥迪氏括约肌肌电活动加强,与在NRO内微量注射生理盐水或者将谷氨酸（340mmol/L,0.4ul)注射到NRO以外的地方相比,具有显著差异（P＜0．01）,NRO 微量注射N-methy-D-aspartate(NM-DA)受体阻断剂氯胺酮（180mmol/L,0.1ul),可消除谷氨酸的效应,而将微量非NMDA受体阻断剂CNQX（2mmol/L,0.1ul)注入NRO,可使奥迪氏括约肌肌电加强,外周应用M－受体阻断剂阿托品（0.2mg/kg)或双侧颈部迷走神经切断,可阻断微量谷氨酸注射到NRO内所引起的效应,静脉注射α－受体阻断剂酚妥拉明（1.5mg/kg),心得安（1.5mg/kg)或自T3－4处切断脊髓,对NRO内微量注射谷氨酸的效应没有影响,结果提示,NRO对奥迪氏括约肌运行有调节作用,其中谷氨酸主要通过NMDA受体兴雷奥迪氏括约肌肌电活动,其传出途径是迷走神经和外周M受体。     

Evaluation of multiple-point measurement of sphincter of Oddi motility in the Australian brush-tailed possum

Manometric assembly diameter is a major limitation on the number of perfused manometric recording points for recordings from the sphincter of Oddi (SO). We evaluated novel polyimide manometric assemblies whereby four recording channels were incorporated in an overall assembly diameter of 0.8 mm. Over the very low range of perfusion rates tested (0.005-0.04 ml/min), the assemblies had pressure offsets attributable to water perfusion from 2 to 23 mmHg and pressure rise rates from 20 to 163 mmHg/s. In six anesthetized Australian brush-tailed possums, manometric recordings from the SO showed a significant reduction in the recorded peak amplitude of pressure waves with perfusion rates below 0.02 ml/min. The pressure profile of the sphincter was found to be asymmetric, and phasic wave propagation patterns were complex (antegrade 35.6%, "mixed" 64.4%). In conclusion, accurate multipoint SO manometry in the possum can be performed with micromanometric assemblies at very low perfusion rates to give a more complete understanding of SO mechanics. These methods are also potentially applicable to perfusion manometry in other small laboratory animals such as mice.     

Oddi括约肌收缩运动与十二指肠MMC相关性的实验研究

目的:确定Oddi括约肌收缩运动与十二指肠移行性运动综合波(migrating motor complex,MMC)的相互关系,提高对胆道机能失调性疾病的诊断或药物对Oddi括约肌影响的评价.方法:四只杂种成犬行十二指肠Thomas造瘘,微量灌流法连续测定十二指肠和Oddi括约肌收缩运动.结果:Oddi括约肌伴随十二指肠MMC呈周期性收缩运动,平均基础压、振幅和收缩频率在十二指肠MMC的1期,不受十二指肠收缩的影响,相对稳定.与2期或3期相比,差异显著(P＜0.01).结论:阐述Oddi括约肌收缩功能或研究药物对Oddi括约肌的作用时,应注意十二指肠对Oddi括约肌的影响.     

NO对家兔Oddi括约肌肌电活动和血压的影响

应用３２只家兔观察一氧氮对Ｏｄｄｉ括约肌肌电和血压的影响。静脉注射ＮＯ合酶抑制剂Ｎ＾Ｇ－硝基－Ｌ－精氨酸,可见ＳＯ肌电振幅增大和血压升高,Ｌ－ＮＮＡ所致的肌电活动增强可Ｌ－精氨酸反转。     

Lamellated bodies in the neurons of the submucosal ganglia in the sphincter of Oddi of the dog.

Peculiar neurons and nerve processes, which contained remarkable amounts of lamellated, electron-dense bodies, "myeloid bodies", are described. They were found among normal looking neurons in the submucosal ganglia of the sphincteric musculature of Oddi. The innervation and ultrastructure of the ganglia were studied in apparently healthy, young dogs bred for experimental purposes. The possible function of these neurons and processes is discussed.     

Differentiation of the effects of antispasmodic agents on the electromyogram of the sphincter of Oddi and the duodenum of the alert rabbit

The electrical activity of the sphincter of Oddi and gastro-intestinal tract had been recorded on 21 negative atropineesterase conscious rabbits by means of chronically implanted electrodes located in the digestive wall. An analysis of the action of different spasmolytic and analgesic drugs was realized. Electromyograms of the sphincter of Oddi presented (a) isolated or in series spike potentials occurring independently of electrical activities of the duodenum (b) recurring spike potentials correlated with intestine spikes. The independent activity of the sphincter of Oddi was not controlled by the cholinergic system, contrary to the intestine-dependent activity (effect of the fempiverinium, atropine like drug). The pitofenone had inhibited the spike potentials of both the sphincter and intestine because its papaverinic effect. The noramidopyrine, analgesic drug without morphine-like effects, had induced activation and inhibition at low and high posology respectively.     

Distension of the esophagogastric junction augments triggering of transient lower esophageal sphincter relaxation

Patients with gastroesophageal reflux disease show an increase in esophagogastric junction (EGJ) distensibility and in frequency of transient lower esophageal sphincter relaxations (TLESR) induced by gastric distension. The objective was to study the effect of localized EGJ distension on triggering of TLESR in healthy volunteers. An esophageal manometric catheter incorporating an 8-cm internal balloon adjacent to a sleeve sensor was developed to enable continuous recording of EGJ pressure during distension of the EGJ. Inflation of the balloon doubled the cross-section of the trans-sphincteric portion of the catheter from 5 mm OD (round) to 5 × 11 mm (oval). Ten healthy subjects were included. After catheter placement and a 30-min adaptation period, the EGJ was randomly distended or not, followed by a 45-min baseline recording. Subjects consumed a refluxogenic meal, and recordings were made for 3 h postprandially. A repeat study was performed on another day with EGJ distension status reversed. Additionally, in one subject MRI was performed to establish the exact position of the balloon in the inflated state. The number of TLESR increased during periods of EGJ distension with the effect being greater after a meal [baseline: 2.0(0.0-4.0) vs. 4.0(1.0-11.0), P=0.04; postprandial: 15.5(10.0-33.0) vs. 22.0(17.0-58.0), P=0.007 for undistended and distended, respectively]. EGJ distension augments meal-induced triggering of TLESR in healthy volunteers. Our data suggest the existence of a population of vagal afferents located at sites in/around the EGJ that may influence triggering of TLESR.     

A novel pattern of longitudinal muscle contraction with subthreshold pharyngeal stimulus: a possible mechanism of lower esophageal sphincter relaxation

A subthreshold pharyngeal stimulus induces lower esophageal sphincter (LES) relaxation and inhibits progression of ongoing peristaltic contraction in the esophagus. Recent studies show that longitudinal muscle contraction of the esophagus may play a role in LES relaxation. Our goal was to determine whether a subthreshold pharyngeal stimulus induces contraction of the longitudinal muscle of the esophagus and to determine the nature of this contraction. Studies were conducted in 16 healthy subjects. High resolution manometry (HRM) recorded pressures, and high frequency intraluminal ultrasound (HFIUS) images recorded longitudinal muscle contraction at various locations in the esophagus. Subthreshold pharyngeal stimulation was induced by injection of minute amounts of water in the pharynx. A subthreshold pharyngeal stimulus induced strong contraction and caudal descent of the upper esophageal sphincter (UES) along with relaxation of the LES. HFIUS identified longitudinal muscle contraction of the proximal (3-5 cm below the UES) but not the distal esophagus. Pharyngeal stimulus, following a dry swallow, blocked the progression of dry swallow-induced peristalsis; this was also associated with UES contraction and descent along with the contraction of longitudinal muscle of the proximal esophagus. We identify a unique pattern of longitudinal muscle contraction of the proximal esophagus in response to subthreshold pharyngeal stimulus, which we propose may be responsible for relaxation of the distal esophagus and LES through the stretch sensitive activation of myenteric inhibitory motor neurons.     

Distribution of nitric oxide synthase and vasoactive intestinal polypeptide immunoreactivity in the sphincter of Oddi and duodenum of the possum

The nitrergic innervation of the sphincter of Oddi (SO) and duodenum in the Australian brush-tailed possum and the possible association of this innervation with the neuropeptide vasoactive intestinal polypeptide (VIP) were investigated by using immunohistochemical localisation of nitric oxide synthase (NOS) and VIP, together with the general neuronal marker, protein gene product 9.5 (PGP9.5). Whole-mount preparations of the duodenum and attached SO without the mucosa, submucosa and circular muscle (n=12) were double- and triple-labelled. The density of myenteric nerve cell bodies of the SO in the more distal region (duodenal end) was significantly higher than that in the more proximal region. In the SO, approximately 50% of all cells were NOS-immunoreactive (IR), with 27% of the NOS-IR cells being VIP-IR. Within the duodenal myenteric plexus, NOS immunoreactivity was present in about 25% of all neurons, with 27% of these NOS-IR neurons also being VIP-IR, a similar proportion to that in the SO. Varicose nerve fibres with NOS and VIP immunoreactivity were present within the myenteric and submucous plexuses of the SO and duodenum, and in the circular and longitudinal muscle layers. The NOS-positive cells within both the SO and duodenum were unipolar, displaying a typical Dogiel type I morphology. The myenteric plexuses of the SO and duodenum were in direct continuity, with many interconnecting nerve trunks, some of which showed NOS and VIP immunoreactivity. Thus, the possum possesses an extensive NOS innervation of the SO and duodenum, with a significantly higher proportion of NOS-IR neurons within the SO, a subset of which contains VIP.     

Biomechanics of failed deglutitive upper esophageal sphincter relaxation in neurogenic dysphagia

Our aims were to examine the etiology and biomechanical properties of the nonrelaxing upper esophageal sphincter (UES) and the relationship between UES opening and failed relaxation. We examined the relationships among swallowed bolus volume, intrabolus pressure, sagittal UES diameter, the pharyngeal swallow response, and geniohyoid shortening in 18 patients with failed UES relaxation, 23 healthy aged controls, and 15 with Zenker's diverticulum. Etiology of failed UES relaxation was 56% medullary disease, 33% Parkinson's or extrapyramidal disease; and 11% idiopathic. Extent of UES opening ranged from absent to normal and correlated with preservation of the pharyngeal swallow response (P = 0.012) and geniohyoid shortening (P = 0.046). Intrabolus pressure was significantly greater compared with aged controls (P < 0.001) or Zenker's diverticulum (P < 0.001). The bolus volume-dependent increase in intrabolus pressure evident in controls was not observed in failed UES relaxation. The nonrelaxing UES therefore displays a constant loss of sphincter compliance throughout the full, and potentially normal, range of expansion during opening. Adequacy of UES opening is influenced by the degree of preservation of the pharyngeal swallow response and hyolaryngeal traction. In contrast, the stenotic UES displays a static loss of compliance, only apparent once the limit of sphincter expansion is reached.