short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle...
Transcript of short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle...
![Page 1: short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle physiology and pathophysiology Daniel Sifrim Neurogastroenterology Group. PERISTALSIS LES](https://reader034.fdocuments.in/reader034/viewer/2022043000/5f7644b95d055073f73969cc/html5/thumbnails/1.jpg)
Normal esophageal smooth muscle physiology and pathophysiology
Daniel Sifrim
Neurogastroenterology
Group
Daniel Sifrim
![Page 2: short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle physiology and pathophysiology Daniel Sifrim Neurogastroenterology Group. PERISTALSIS LES](https://reader034.fdocuments.in/reader034/viewer/2022043000/5f7644b95d055073f73969cc/html5/thumbnails/2.jpg)
![Page 3: short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle physiology and pathophysiology Daniel Sifrim Neurogastroenterology Group. PERISTALSIS LES](https://reader034.fdocuments.in/reader034/viewer/2022043000/5f7644b95d055073f73969cc/html5/thumbnails/3.jpg)
PERISTALSISPERISTALSIS
LESLES
Esophageal motor patterns
TONETONE
BarostatBarostat(volume)(volume)
Amyl nitriteAmyl nitrite
SHORTENINGSHORTENING
![Page 4: short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle physiology and pathophysiology Daniel Sifrim Neurogastroenterology Group. PERISTALSIS LES](https://reader034.fdocuments.in/reader034/viewer/2022043000/5f7644b95d055073f73969cc/html5/thumbnails/4.jpg)
ESOPHAGEAL PERISTALSIS
![Page 5: short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle physiology and pathophysiology Daniel Sifrim Neurogastroenterology Group. PERISTALSIS LES](https://reader034.fdocuments.in/reader034/viewer/2022043000/5f7644b95d055073f73969cc/html5/thumbnails/5.jpg)
The CM and LM layers contract and relax together during the ascending contraction and descending during the ascending contraction and descending relaxation of the peristaltic reflex, respectively. The synchrony and asynchrony between the two layers is of fundamental importance to bolus propulsion in the antegrade and retrograde directions, respectively.
![Page 6: short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle physiology and pathophysiology Daniel Sifrim Neurogastroenterology Group. PERISTALSIS LES](https://reader034.fdocuments.in/reader034/viewer/2022043000/5f7644b95d055073f73969cc/html5/thumbnails/6.jpg)
Control of esophageal peristalsisLevels of control
�� Central (striated and smooth muscle)Central (striated and smooth muscle)»» Cortical Cortical -- voluntaryvoluntary»» Brain stem Brain stem -- central pattern generator (CPG)central pattern generator (CPG)
�� Peripheral (smooth muscle)Peripheral (smooth muscle)�� Peripheral (smooth muscle)Peripheral (smooth muscle)»» Neural Neural -- excitation and inhibitionexcitation and inhibition»» MyogenicMyogenic»» Interstitial Interstitial cells of cells of CajalCajal (ICC)(ICC)
�� CentralCentral--peripheral peripheral connection (brainconnection (brain--gutgut--brain)brain)
Diamant 1997
![Page 7: short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle physiology and pathophysiology Daniel Sifrim Neurogastroenterology Group. PERISTALSIS LES](https://reader034.fdocuments.in/reader034/viewer/2022043000/5f7644b95d055073f73969cc/html5/thumbnails/7.jpg)
Central Neural Control of Esophageal Motor Function
Striatedmuscle
IXIX
Smoothmuscle
Transitionzone Nucleus
ambiguus
Dorsal motorNucleus
![Page 8: short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle physiology and pathophysiology Daniel Sifrim Neurogastroenterology Group. PERISTALSIS LES](https://reader034.fdocuments.in/reader034/viewer/2022043000/5f7644b95d055073f73969cc/html5/thumbnails/8.jpg)
What is the role of the What is the role of the myenteric neurons in the myenteric neurons in the proximal esophagus? proximal esophagus?
Mashimo GI motility on LineMashimo GI motility on Line
![Page 9: short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle physiology and pathophysiology Daniel Sifrim Neurogastroenterology Group. PERISTALSIS LES](https://reader034.fdocuments.in/reader034/viewer/2022043000/5f7644b95d055073f73969cc/html5/thumbnails/9.jpg)
Mashimo GI motility on LineMashimo GI motility on Line
![Page 10: short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle physiology and pathophysiology Daniel Sifrim Neurogastroenterology Group. PERISTALSIS LES](https://reader034.fdocuments.in/reader034/viewer/2022043000/5f7644b95d055073f73969cc/html5/thumbnails/10.jpg)
Hirano I. GI Motility on Line
![Page 11: short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle physiology and pathophysiology Daniel Sifrim Neurogastroenterology Group. PERISTALSIS LES](https://reader034.fdocuments.in/reader034/viewer/2022043000/5f7644b95d055073f73969cc/html5/thumbnails/11.jpg)
Control of esophageal peristalsisSmooth Muscle
�� CentralCentral»» programmed vagal excitationprogrammed vagal excitation»» programmed vagal inhibition?programmed vagal inhibition?
�� Peripheral (smooth muscle)Peripheral (smooth muscle)»» Neural Neural -- excitation and inhibition with regional variationexcitation and inhibition with regional variation
MyogenicMyogenic--oscillator propertiesoscillator properties»» MyogenicMyogenic--oscillator propertiesoscillator properties
»» Interstitial Interstitial cells of cells of CajalCajal (ICC)transducer; pacemaker?(ICC)transducer; pacemaker?
�� Amplitude Amplitude -- central > peripheralcentral > peripheral
�� VelocityVelocity -- peripheral > centralperipheral > central
Diamant 1997
![Page 12: short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle physiology and pathophysiology Daniel Sifrim Neurogastroenterology Group. PERISTALSIS LES](https://reader034.fdocuments.in/reader034/viewer/2022043000/5f7644b95d055073f73969cc/html5/thumbnails/12.jpg)
Central Neural ControlCentral Neural Control»» Coordinates the Coordinates the
peristaltic activity peristaltic activity between striated and between striated and smooth muscle smooth muscle portionportionportionportion
»» Can initiate the Can initiate the activity in the smooth activity in the smooth muscle portionmuscle portion
Janssens et al 1976
![Page 13: short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle physiology and pathophysiology Daniel Sifrim Neurogastroenterology Group. PERISTALSIS LES](https://reader034.fdocuments.in/reader034/viewer/2022043000/5f7644b95d055073f73969cc/html5/thumbnails/13.jpg)
Transition between striated muscle and smooth muscle Transition between striated muscle and smooth muscle contractile activitycontractile activity
Ghosh et al 2008Ghosh et al 2008
![Page 14: short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle physiology and pathophysiology Daniel Sifrim Neurogastroenterology Group. PERISTALSIS LES](https://reader034.fdocuments.in/reader034/viewer/2022043000/5f7644b95d055073f73969cc/html5/thumbnails/14.jpg)
Peripheral control Peripheral control of peristalsisof peristalsis
�� Neural Neural -- excitation and inhibition with regional excitation and inhibition with regional variationvariation
�� MyogenicMyogenic--oscillator oscillator propertiesproperties
�� Interstitial cells of Interstitial cells of CajalCajal (ICC)transducer; pacemaker(ICC)transducer; pacemaker??
�� Neuronal stretch activationNeuronal stretch activation
![Page 15: short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle physiology and pathophysiology Daniel Sifrim Neurogastroenterology Group. PERISTALSIS LES](https://reader034.fdocuments.in/reader034/viewer/2022043000/5f7644b95d055073f73969cc/html5/thumbnails/15.jpg)
Continuous reactivation of descending inhibitory Continuous reactivation of descending inhibitory pathway by proximal contraction / bolus distentionpathway by proximal contraction / bolus distention
Latency gradient is due to continuous reactivation of descending inhibitory Latency gradient is due to continuous reactivation of descending inhibitory pathway by proximal contraction / bolus distentionpathway by proximal contraction / bolus distention
Paterson 1999Paterson 1999
![Page 16: short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle physiology and pathophysiology Daniel Sifrim Neurogastroenterology Group. PERISTALSIS LES](https://reader034.fdocuments.in/reader034/viewer/2022043000/5f7644b95d055073f73969cc/html5/thumbnails/16.jpg)
![Page 17: short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle physiology and pathophysiology Daniel Sifrim Neurogastroenterology Group. PERISTALSIS LES](https://reader034.fdocuments.in/reader034/viewer/2022043000/5f7644b95d055073f73969cc/html5/thumbnails/17.jpg)
Myogenic control of esophageal peristalsis
![Page 18: short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle physiology and pathophysiology Daniel Sifrim Neurogastroenterology Group. PERISTALSIS LES](https://reader034.fdocuments.in/reader034/viewer/2022043000/5f7644b95d055073f73969cc/html5/thumbnails/18.jpg)
EndoflipEndoflip RACSRACS
![Page 19: short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle physiology and pathophysiology Daniel Sifrim Neurogastroenterology Group. PERISTALSIS LES](https://reader034.fdocuments.in/reader034/viewer/2022043000/5f7644b95d055073f73969cc/html5/thumbnails/19.jpg)
Interstitial cells of Cajal (ICC)
Faussone-Pelegrini and Cortesini 1985
![Page 20: short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle physiology and pathophysiology Daniel Sifrim Neurogastroenterology Group. PERISTALSIS LES](https://reader034.fdocuments.in/reader034/viewer/2022043000/5f7644b95d055073f73969cc/html5/thumbnails/20.jpg)
central and peripheral vagal controlcentral and peripheral vagal control
JiJi--Hong Chen 2016Hong Chen 2016
![Page 21: short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle physiology and pathophysiology Daniel Sifrim Neurogastroenterology Group. PERISTALSIS LES](https://reader034.fdocuments.in/reader034/viewer/2022043000/5f7644b95d055073f73969cc/html5/thumbnails/21.jpg)
![Page 22: short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle physiology and pathophysiology Daniel Sifrim Neurogastroenterology Group. PERISTALSIS LES](https://reader034.fdocuments.in/reader034/viewer/2022043000/5f7644b95d055073f73969cc/html5/thumbnails/22.jpg)
![Page 23: short Normal esophageal smooth muscle physiology and ... · Normal esophageal smooth muscle physiology and pathophysiology Daniel Sifrim Neurogastroenterology Group. PERISTALSIS LES](https://reader034.fdocuments.in/reader034/viewer/2022043000/5f7644b95d055073f73969cc/html5/thumbnails/23.jpg)
PERISTALSISPERISTALSIS
LESLES
Esophageal motor patterns
TONETONE
BarostatBarostat(volume)(volume)
Amyl nitriteAmyl nitrite
SHORTENINGSHORTENING