title: Circular and longitudinal muscles shortening indicates sliding patterns during peristalsis and transient lower esophageal sphincter relaxation.
abstract: Esophageal axial shortening is caused by longitudinal muscle (LM) contraction, but circular muscle (CM) may also contribute to axial shortening because of its spiral morphology. The goal of our study was to show patterns of contraction of CM and LM layers during peristalsis and transient lower esophageal sphincter (LES) relaxation (TLESR). In rats, esophageal and LES morphology was assessed by histology and immunohistochemistry, and function with the use of piezo-electric crystals and manometry. Electrical stimulation of the vagus nerve was used to induce esophageal contractions. In 18 healthy subjects, manometry and high frequency intraluminal ultrasound imaging during swallow-induced esophageal contractions and TLESR were evaluated. CM and LM thicknesses were measured (40 swallows and 30 TLESRs) as markers of axial shortening, before and at peak contraction, as well as during TLESRs. Animal studies revealed muscular connections between the LM and CM layers of the LES but not in the esophagus. During vagal stimulated esophageal contraction there was relative movement between the LM and CM. Human studies show that LM-to-CM (LM/CM) thickness ratio at baseline was 1. At the peak of swallow-induced contraction LM/CM ratio decreased significantly (<1), whereas the reverse was the case during TLESR (>2). The pattern of contraction of CM and LM suggests sliding of the two muscles. Furthermore, the sliding patterns are in the opposite direction during peristalsis and TLESR.
authors.affiliation: Department of Medicine, University of California San Diego, San Diego, California; and.
authors.forename: Nirali
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of Medicine, University of California San Diego, San Diego, California; and.
authors.forename: Yanfen
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Department of Medicine, University of California San Diego, San Diego, California; and San Diego Veterans Affairs Healthcare System, San Diego, California.
authors.forename: Ravinder K
authors.initials: RK
authors.lastname: Mittal
authors.affiliation: Department of Medicine, University of California San Diego, San Diego, California; and.
authors.forename: Tae Ho
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Department of Medicine, University of California San Diego, San Diego, California; and.
authors.forename: Melissa
authors.initials: M
authors.lastname: Ledgerwood
authors.affiliation: Department of Medicine, University of California San Diego, San Diego, California; and San Diego Veterans Affairs Healthcare System, San Diego, California vbhargava@ucsd.edu.
authors.forename: Valmik
authors.initials: V
authors.lastname: Bhargava
mesh_terms: D000328:Adult; D000818:Animals; D049630:Esophageal Sphincter, Lower / Q000294:innervation / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D009119:Muscle Contraction; D009126:Muscle Relaxation; D010528:Peristalsis; D051381:Rats; D017207:Rats, Sprague-Dawley; D014630:Vagus Nerve / Q000502:physiology
keywords: gastroesophageal reflux; muscularis propria; unequal shortening of muscle layers