TY - JOUR
T1 - Repetitive antegrade contraction
T2 - A novel response to sustained esophageal distension is modulated by cholinergic influence
AU - Carlson, Dustin A.
AU - Kou, Wenjun
AU - Masihi, Melina
AU - Acharya, Shashank
AU - Baumann, Alexandra J.
AU - Donnan, Erica N.
AU - Kahrilas, Peter J.
AU - Pandolfino, John E.
N1 - Funding Information:
This work was supported by National Institute of Diabetes and Digestive and Kidney Diseases Grant P01 DK117824 (to J. E. Pandolfino) and by an American College of Gastroenterology Junior Faculty Development Award (to D. A. Carlson).
Publisher Copyright:
Copyright © 2020 the American Physiological Society.
PY - 2020/12
Y1 - 2020/12
N2 - A unique motor response to sustained esophageal distension, repetitive antegrade contractions (RACs), is observed using functional luminal imaging probe (FLIP) panometry. However, physiological mechanisms related to this response are unexplored. This study aimed to evaluate the impact of cholinergic inhibition with atropine on the esophageal contractile response to sustained distention, including RACs, among healthy volunteers. Eight asymptomatic volunteers (ages 22-45 yr) were evaluated in a crossover study design with 16-cm FLIP positioned across the esophagogastric junction and distal esophagus during sedated upper endoscopy. The FLIP study involving stepwise volumetric distension was performed twice in each subject, at baseline, and again after atropine (15 μg/kg) was administered intravenously. FLIP panometry data were analyzed to assess the contractile response to distension. Antegrade contractions, lumen-occluding contractions, and a RAC pattern were observed in 8/8, 8/8, and 7/8 (88%) subjects, respectively, at baseline and in 5/8 (63%), 2/8 (25%), and 2/8 (25%) subjects after atropine. The rate of contractions in the RAC pattern was similar (6-7 contractions per minute) before and after atropine. Compared with the baseline study, distension-induced contractility was triggered at higher fill volumes after atropine. FLIP pressures were lower in response to volumetric filling after atropine than at baseline. The vigor and triggering of the esophageal contractile response to distension is reduced by cholinergic inhibition in asymptomatic controls. The observation that the rate of contractions did not change when patients developed repetitive contractile responses suggests that this rate is not modified by cholinergic inhibition once contractility is triggered. NEW & NOTEWORTHY Repetitive antegrade contraction, a unique, patterned, motor response to sustained esophageal distension, is observed on functional luminal imaging probe panometry in healthy controls and patients with normal esophageal motility; however, the mechanisms related to this response are unclear. Among healthy, asymptomatic volunteers, cholinergic inhibition with atropine reduced the vigor and triggering of distension-induced esophageal contractility, although the rate at which contractions occurred in a repetitive antegrade contraction pattern was unchanged by atropine.
AB - A unique motor response to sustained esophageal distension, repetitive antegrade contractions (RACs), is observed using functional luminal imaging probe (FLIP) panometry. However, physiological mechanisms related to this response are unexplored. This study aimed to evaluate the impact of cholinergic inhibition with atropine on the esophageal contractile response to sustained distention, including RACs, among healthy volunteers. Eight asymptomatic volunteers (ages 22-45 yr) were evaluated in a crossover study design with 16-cm FLIP positioned across the esophagogastric junction and distal esophagus during sedated upper endoscopy. The FLIP study involving stepwise volumetric distension was performed twice in each subject, at baseline, and again after atropine (15 μg/kg) was administered intravenously. FLIP panometry data were analyzed to assess the contractile response to distension. Antegrade contractions, lumen-occluding contractions, and a RAC pattern were observed in 8/8, 8/8, and 7/8 (88%) subjects, respectively, at baseline and in 5/8 (63%), 2/8 (25%), and 2/8 (25%) subjects after atropine. The rate of contractions in the RAC pattern was similar (6-7 contractions per minute) before and after atropine. Compared with the baseline study, distension-induced contractility was triggered at higher fill volumes after atropine. FLIP pressures were lower in response to volumetric filling after atropine than at baseline. The vigor and triggering of the esophageal contractile response to distension is reduced by cholinergic inhibition in asymptomatic controls. The observation that the rate of contractions did not change when patients developed repetitive contractile responses suggests that this rate is not modified by cholinergic inhibition once contractility is triggered. NEW & NOTEWORTHY Repetitive antegrade contraction, a unique, patterned, motor response to sustained esophageal distension, is observed on functional luminal imaging probe panometry in healthy controls and patients with normal esophageal motility; however, the mechanisms related to this response are unclear. Among healthy, asymptomatic volunteers, cholinergic inhibition with atropine reduced the vigor and triggering of distension-induced esophageal contractility, although the rate at which contractions occurred in a repetitive antegrade contraction pattern was unchanged by atropine.
KW - Anticholinergic
KW - Manometry
KW - Motility
KW - Peristalsis
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U2 - 10.1152/AJPGI.00305.2020
DO - 10.1152/AJPGI.00305.2020
M3 - Article
C2 - 33026823
AN - SCOPUS:85098087451
SN - 0193-1857
VL - 319
SP - G696-G702
JO - American Journal of Physiology - Gastrointestinal and Liver Physiology
JF - American Journal of Physiology - Gastrointestinal and Liver Physiology
IS - 6
ER -