Effect of straining on the lower esophageal sphincter: identification of the "straining-esophageal reflex" and its role in gastroesophageal competence mechanism

Journal of Investigative Surgery : the Official Journal of the Academy of Surgical Research
Ahmed ShafikIsmail Shafik

Abstract

The lower esophagus is intra-abdominal and exposed to intra-abdominal pressure (IAP) variations that may lead to gastroesophageal reflux (GER). We investigated the hypothesis that the lower esophageal sphincter (LES) undergoes phasic contraction on IAP increase, with a resulting inhibition of the stress GER. The study comprised 17 subjects (age 42.3 +/- 8.7 SD yr, 10 men, 7 women) who were scheduled for surgical repair of abdominal hernia. The patients had no swallowing problems. The electromyographic (EMG) activity of the LES and pressure within the LES were recorded at rest and during increased IAP (coughing, straining). The recording was repeated after LES anesthetization or saline infiltration. The LES EMG at rest showed regular slow waves (SWs), superimposed on or followed by random action potentials (APs). Coughing or straining induced increase of the SWs parameters and also of the APs; although the increase with straining was less than with coughing, the difference was insignificant. Coughing or straining increased the LES pressure significantly (p < .05, p < .05, respectively). Ten minutes after LES anesthetization, coughing or straining did not produce significant LES EMG or pressure changes, while saline infiltration ...Continue Reading

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Citations

Sep 6, 2012·Pediatric Pulmonology·Laura J MiskeHoward B Panitch
Apr 8, 2006·Respiratory Physiology & Neurobiology·Giovanni A Fontana, Federico Lavorini

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