Nippon Shokakibyo Gakkai Zasshi
Online ISSN : 1349-7693
Print ISSN : 0446-6586
LES relaxation in achalasia patients
effect of caerulein
Hiroaki UJIIEMichio HONGOKenzo SATAKEYo OKUNOYoshio GOTO
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Keywords: T-LESR, CCK
JOURNAL FREE ACCESS

1988 Volume 85 Issue 11 Pages 2351-2358

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Abstract

Transient LES relaxation, which occurs independently from swallowing effort, is one of the main mechanism of gastro-esophageal reflux. In achalasia patietns, incomplete LES relaxation is one of the characteristic manometric finding, along with loss of peristalsis. We monitored basal LES pressure for 30 minutes in 15 achalasia patients, and transient LES relaxation was observed in 7 patients. CCK has been reported to stimulate inhibitory neuron to LES in normal subjects and in animals. Therefore we monitored LES response to caerulein, which has similar biological effects to CCK, in achalasia patients to see i) whether achalasia patients have abnormality in inhibitory neuron to LES, and ii) whether transient LES relaxation is related to caerulein sensitive mechanism. Within 5 minutes after injection of caerulein 40ng/kg iv in 15 patients, total of 14 LES relaxations were observed in 8 patients. LES pressure decreased in 12 patients, and the increase of LES was observed in 2 patients. Caerulein induced LES relaxation was observed in 86% (6/7) of patients who had transient LES relaxations during basal period. We conclude that mechanism which is sensitive to caerulein may be involved in transient LES relaxation in achalasia patients. The peripheral neural mechanism concerned with LES relaxation might remain intact in some of achalasia patients. We speculated that there may be wide variation in level or degree of neural damage in achalasia patients.

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© The Japanese Society of Gastroenterology
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