Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0014848 (achalasia)
 2,804 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Studies were carried out in a case of achalasia. Administration of secretin caused relaxation of the spastic condition of LES, and high levels of serum gastrin and lower levels of plasma secretin are suggested to be related with the abnormally spastic condition of LES in the patient.
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PMID:Studies on exogenous and endogenous interaction of gastrin and secretin in a case of achalasia. 59 72

Lower oesophageal sphincter response to infusion of graded doses (0.003--0.050 microgram kg-1min-1) of pentagastrin was evaluated in four antrectomised patients as well as in six healthy subjects and seven achalasic patients in whom inhibition of antral gastrin release was maintained by continuous acidification (HC1 0.1 N) and aspiration of gastric antrum. In normal subjects and in antrectomised patients doses of pentagastrin required for half-maximal gastric acid secretion (0.012 microgram kg-1min-1) produced statistically significant increases of LES pressure. In achalasic patients, the infusion of pentagastrin did not affect LES pressure. These data seem to indicate that gastrin plays, at least in some degree, a physiological role in the regulation of LES tone. Insensitivity of LES to pentagastrin in achalasia suggests that the raised sphincter pressure in this disorder can not be attributed to gastrin.
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PMID:Lower oesophageal sphincter response to intravenous infusions of pentagastrin in normal subjects, antrectomised and achalasic patients. 74 97

Previous reports on the profile of lower oesophageal sphincter (LOS) pressures and swallow responses in achalasia have been conflicting. Both normal and high resting pressures have been reported. Many reports have noted a failure of relaxation of the LOS in response to swallowing. Manometric studies were performed on 17 untreated patients with achalasia, of whom 76% were found to have a resting peak end-inspiratory pressure significantly greater than normal (P = 0,001). Nine patients showed relaxation of the LOS in response to swallowing but this relaxation was usually inadequate and of brief duration. Contractions were premature in 16 patients. One patient showed a manometric pattern closely simulating a Mobitz type 1 atrioventricular block in response to repeated swallows. A common pathophysiological process is postulated. In one patient an injection of secretin reduced the high resting LOS pressure. This supports previous evidence that a hypersensitive sphincter in achalasia is due to a hypersensitivity to gastrin. Hyoscine-N-butylbromide (Buscopan) caused a significant reduction in LOS pressure in all patients in whom it was used.
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PMID:Lower oesophageal sphincter resting pressures in achalasia and the response of the sphincter to swallowing and drugs. 99 80

Resting lower esophageal sphincter pressures and fasting serum gastrin levels were measured in 35 consecutive patients. 28 of these patients were subdivided into Group I, which consisted of 9 patients with symptomatic gastroesophageal reflux and hiatus hernia, and Group II was further subdivided into Group IIA, 5 patients with hiatus hernias, and Group IIB, 14 patients without hiatus hernia. Mean LES pressures for Groups I, IIA, and IIB were 9.7, 36.8, and 25.6 cm H2O, and serum gastrin levels were 129, 74, and 116 pg/ml, respectively. Examination of these data as a whole or as subgroups failed to demonstrate a correlation between these two variables. The remaining 7 patients had abnormal sphincters (3 patients which scleroderma and 2 with achalasia) or abnormal serum gastrin levels (1 patient with pernicious anemia and 1 patient with antrectomy and Billroth II anastomosis). For these patients as well, no correlation between LES pressure and serum gastrin level was found. These results cast doubt on the hypothesis that endogenous gastrin is a major factor in the maintenance of resting LES pressure.
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PMID:Correlation of lower esophageal sphincter pressure and serum gastrin level in man. 114 86

Smooth muscle specimens were taken from the lower esophageal sphincter of patients suffering from achalasia or hiatus hernia with gastro-esophageal reflux. The specimens were analysed for neurohormonal peptides using immunochemistry and immunocytochemistry. Control specimens were obtained from patients subjected to esophageal resection because of esophageal cancer. The concentration of vasoactive intestinal polypeptide (VIP) was higher and the VIP nerve supply greater in patients with hiatus hernia than in control patients. The VIP nerve supply and the content of this peptide was lower in patients with achalasia than in controls. The same tendency was observed for substance P and enkephalin although the changes in their concentrations were not statistically significant. Enkephalin fibers were few, both in specimens from control patients and from patients with hiatus hernia; they could not be detected in specimens from patients with achalasia. Never fibers containing somatostatin or gastrin/cholecystokinin could not be detected in any of the groups and somatostatin and gastrin/cholecystokinin could not be measured in extracts of the lower esophageal sphincter. We propose that changes in the concentration of neuropeptides may at least contribute to manifestations of achalasia and of decreased lower esophageal sphincter pressure and gastro-esophageal reflux.
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PMID:Regulatory peptides in the lower esophageal sphincter of man. 258 Dec 86

Lower oesophageal sphincter supersensitivity to gastrin I and cholinergic stimulation has recently been described in patients with achalasia. To determine the pathogenesis of this finding, the lower oesophageal sphincter was tested to a cholinesterase inhibitor, edrophonium chloride. Edrophonium chloride significantly increased the lower oesophageal sphincter pressure both in normal subjects and in patients with achalasia. The preservation of this response in the presence of denervation supersensitivity suggested intact postganglionic cholinergic nerves and, thus, a preganglionic site of denervation in achalasia.
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PMID:The site of denervation in achalasia. 506 32

Intraluminal manometric studies were carried out in 19 patients with untreated achalasia and in 20 normals. Lower esophageal sphincter (LES) pressure was 50.5 +/-4.6 mm Hg in patients with achalasia as compared with 19.4 +/-1.3 mm Hg in the normal group. In both groups, the LES pressure was lowered when exogenous 0.1 N HCl was placed into the stomach. Although the nadir of pressure attained with acid suppression was the same, the per cent inhibition was significantly greater in patients with achalasia. Serum gastrin levels were the same in the two groups studied. The patients with achalasia, pre- and postpneumatic dilatation, showed a supersensitivity to exogenous intravenous gastrin I, as compared with normals. These data suggest that high, acid-suppressible levels of LES pressure, in patients with achalasia, are due to supersensitivity to endogenous gastrin.
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PMID:Role of gastrin supersensitivity in the pathogenesis of lower esophageal sphincter hypertension in achalasia. 557 32

Serum gastrin and lower esophageal sphincter (LES) responses to somatostatin infusion were evaluated in ten normal subjects and in nine achalasic patients in order to determine evidence of hormonal (presumably gastrin)control of LES pressure. After somatostatin infusion, a significant decrease of serum gastrin was observed in normal subjects at 30 min (81.6 +/- 3.2 versus 40.0 +/- 4.7 pg/ml; p less than 0.01) and a rapid increase of LES pressure was also observed (26.0 +/- 1.3 versus 34.1 +/- 1.6 mmHg; p less than 0.01). In achalasia no change was observed in serum gastrin concentration after somatostatin infusion. LES pressure at 20 min however significantly decreased (45.8 +/- 7.6 versus 31.6 +/- 2.3 mmHg; p less than 0.05). Endogenous gastrin is not a major control factor for LES pressure in either normal or achalasic subjects.
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PMID:Effect of somatostatin on lower esophageal sphincter (les) pressure and serum gastrin in normal and achalasic subjects. 612 Aug 88

The present study was designed to investigate basic and clinical problems of intraluminal lower esophageal sphincter (LES) manometry. As for the basic study, manometry apparatuses, measuring conditions and methods were revalued. For clinical study, effects of gastric contents and gastrin were studied with special reference to the asymmetry of the LES. The results obtained may be summarized as follows: Occlusion test performed in a LES model and dogs showed that the rate of pressure increase was greater in proportion to the greater perfusion rate as well as to smaller calibre of the manometry tube. The lower esophageal sphincter pressure (LESP) became greatest when the perfusion rate was increased up to a certain level and also when the withdrawal speed of a manometry tube was slowed down to a certain speed. Analysis of LES from the point of respiratory reversal disclosed that the pressure was greatest at the direction of 8 o'clock followed by those at 0 and 4 o'clock. The length of LES was longest at 4 o'clock followed by those at 0 and 8 o'clock. These differences in length of LES was mostly in accordance with the length of LES caudal to the point of respiratory reversal. LESP measured in different postures was greatest in the prone position suggesting the effect of intraabdominal pressure. Intragastric instillation of saline resulted in increase of intragastric pressure and LESP. Asymmetry of the LES in patients with sliding hiatal hernia, esophageal varices and achalasia showed profiles specific to the individual lesion.
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PMID:[Experimental and clinical studies on the lower esophageal sphincter in reference to its asymmetry and to the effects of respiration, posture and gastric contents]. 718 58

Two approaches of infusion and microtransducer manipulation are available for esophageal manometry. If esophageal peristalsis and relaxation of the lower esophageal sphincter (LES) are diminished, the diagnosis of achalasia can be made. As compared with the infusion method, the microtransducer method requires no perfusion of water and has no limit on posture, allowing successful measurement in an empty esophagus. Thus this method, which allows measurement after feeding and continuous monitoring for 24 hours, seems to be more physiological than the infusion method. With this method, however, peristasis-like contractile waves and relaxation of the LES may be observed in addition to simultaneous contractile waves, even in cases of achalasia. Although methods to observe excessive reactions of the LES often involve a loading test with gastrin or mecolyl in some institutions, a loading test with cerulein is routinely used in our department. In healthy controls, administration of cerulein usually leads to decreased LES pressure, while increased LES pressure is observed in patients with achalasia (paradoxical response).
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PMID:[Diagnosis using esophageal manometry and various loading tests]. 1084 94


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