Influence of breathing pattern on the esophagogastric junction
pressure and esophageal transit.
Mittal, Ravinder K., Hubert A. Shaffer, Stella Parollisi, Lane
Baggett.
DEPARTMENTS OF INTERNAL MEDICINE AND RADIOLOGY, UNIVERSITY OF
VIRGINIA HEALTH SCIENCE CENTER, CHARLOTTESVILLE VIRGINIA 22908.
APStracts 2:0101G, 1995.
BACKGROUND: The esophagogastric junction (EGJ) is guarded by two
sphincters, a smooth muscle lower esophageal sphincter (LES) and a
skeletal muscle crural diaphragm. The LES relaxes in response to a
swallow but the crural diaphragm does not. Since contraction of
crural diaphragm is affected by pattern of breathing, the latter may
also influence the EGJ pressure and swallow induced EGJ relaxation.
AIMS: Our aims were to study the effects of alterations of the
breathing pattern on the EGJ pressure, swallow induced EGJ relaxation
and esophageal transport of liquid bolus. METHODS: Manometric,
electromyographic and videoflouroscopic studies were performed in 12
healthy subjects. The subjects were trained in two types of breathing
patterns, hyperventilation and partial expiration, using the visual
biofeedback from their own respiratory waveform. RESULTS:
Hyperventilation increased the frequency of inspiratory pressure
oscillations at the EGJ without affecting the end-expiratory EGJ
pressure. Partial expiration resulted in an increase in the end
-expiratory EGJ pressure. Swallow induced relaxation at the EGJ was
markedly reduced during partial expiration. An inspiration during a
swallow (control breathing and hyperventilation) caused transient
interruption of flow across the EGJ. Partial expiration resulted in
cessation of the flow across the EGJ, failure of esophageal
peristalsis to traverse the entire length of the esophagus, increased
esophageal transit time and incomplete esophageal clearance of a
liquid bolus. The frequency of bipeaked esophageal contractions was
significantly increased during hyperventilation and partial
expiration. CONCLUSION: The breathing patterns of partial expiration
and hyperventilation have significant influence on esophageal motor
function. Abnormal breathing pattern may be involved in the
pathogenesis of esophageal motor dysfunction.
Received 23 November 1994; accepted in final form 5 May 1995.
APS Manuscript Number G462-4.
Article publication pending Am. J. Physiol. (Gastrointest. Liver
Physiology).
ISSN 1080-4757 Copyright 1995 The American Physiological Society.
Published in APStracts on 30 May 1995.