title: The abnormal lower oesophageal sphincter in pernicious anaemia.
abstract: Lower oesophageal sphincter pressure has been studied in pernicious anaemia patients and controls using an infused open-tipped system. Resting sphincter pressure was significantly (p < 0.01) lower in the pernicious anaemia patients. After gastric acidification with 0.1 N HCl pressure fell significantly (p < 0.01) in both groups. Following subsequent alkalinization, lower oesophageal sphincter pressure for controls rose significantly (p < 0.001). For pernicious anaemia patients the pressure after alkali was not greater than resting levels. Graded intravenous doses of pentagastrin in controls resulted in a peak pressure change of 38.5 +/- 4.9 mm Hg after the 0.8 mug/kg dose. For patients the peak pressure change was only 13.0 +/- 5.2 mm Hg and occurred after 0.4 mug/kg. Cholinergic stimulation with edrophonium (10 mg) produced a peak pressure change of 20.6 +/- 2.6 mm Hg in controls but only 3.5 +/- 1.0 mm Hg in pernicious anaemia patients (p < 0.001). In addition, no change in lower oesophageal sphincter pressure occurred in patients after stimulation with subcutaneous betazole (1.5 mg/kg). In conclusion, the lower oesophageal sphincter in pernicious anaemia is characterized both by a low resting pressure and a decreased response to endogenous and exogenous stimuli. These results suggest a primary end organ defect and most likely indicate abnormal smooth muscle function in pernicious anaemia. Resting sphincter pressure levels and edrophonium response in age-matched subjects indicate that these changes are not due to aging alone.
mesh_terms: D000368:Aged; D000752:Anemia, Pernicious / Q000503:physiopathology*; D004491:Edrophonium / Q000494:pharmacology; D004943:Esophagogastric Junction / Q000503:physiopathology*; D004947:Esophagus / Q000187:drug effects; D005021:Ethylamines / Q000494:pharmacology; D005260:Female; D005755:Gastrins / Q000097:blood; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000503:physiopathology*; D010418:Pentagastrin / Q000494:pharmacology; D011312:Pressure; D011720:Pyrazoles / Q000494:pharmacology; D014805:Vitamin B 12 / Q000627:therapeutic use
chemical_list: D005021:Ethylamines; D005755:Gastrins; D011720:Pyrazoles; D004491:Edrophonium; D010418:Pentagastrin; D014805:Vitamin B 12