Effects of oral erythromycin on upper gastrointestinal motility in patients with non-insulin-dependent diabetes mellitus

Twenty patients (18 males, 2 females) with type II (non-insulin-dependent) diabetes mellitus were enrolled in the study. They were aged 49-72 years (mean age 65 years). Radionuclide-labelled water was used to measure oesophageal motility, expressed as the oesophageal mean transit time (MTT). A radionuclide-labelled solid meal was used to measure gastric motility, expressed as the half-time of gastric emptying (T1/2GET). A baseline study was performed before oral erythromycin therapy. After a 2-week course of treatment, the subjects underwent a second study. Fasting blood sugar (FBS) was also monitored in each study. In the baseline study, MTT was 8.88 +/- 2.00 s and T1/2GET was 198.0 +/- 58.9 min. After treatment with erythromycin, MTT decreased to 7.48 +/- 2.24 s (P < 0.01) and T1/2GET decreased to 137.1 +/- 71.2 min (P < 0.01). In addition, the FBS decreased from 159.0 +/- 40.2 mg dl-1 at baseline to 139.2 +/- 39.8 mg dl-1 after 2 weeks of erythromycin treatment (P < 0.05). We conclude that erythromycin is an effective prokinetic agent for diabetic gastroparesis, and that improved oesophageal transit and gastric emptying may improve glycaemic control.

Photodynamic therapy in Barrett's esophagus: reduction of specialized mucosa, ablation of dysplasia, and treatment of superficial esophageal cancer

Twelve patients with Barrett's esophagus and dysplasia were treated with photodynamic therapy. Five patients also had early, superficial esophageal cancers and five had esophageal polyps. Light was delivered via a standard diffuser or a centering esophageal balloon. Patients were maintained on omeprazole and followed for 6-54 months. In patients with Barrett's esophagus, photodynamic therapy ablated dysplastic mucosa and malignant mucosa in patients with superficial cancer. Healing and partial replacement of Barrett's mucosa with normal squamous epithelium occurred in all patients and complete replacement with squamous epithelium was found in three patients. Side effects included photosensitivity and mild-moderate chest pain and dysphagia for 5-7 days. In four patients with extensive circumferential mucosal ablation in the mid or proximal esophagus, healing was associated with esophageal strictures which were treated successfully by esophageal dilation. Strictures were not found in the distal esophagus. Photodynamic therapy combined with long-term acid inhibition provides effective endoscopic therapy of Barrett's mucosal dysplasia and superficial (Tis-T1) esophageal cancer. The windowed centering balloon improves delivery of photodynamic therapy to diffusely abnormal esophageal mucosa.

Inhibition of substance P-induced vascular leakage in rat by N-acetyl-neurotensin-(8-13)

Substance P (SP) administered 40 micrograms/kg s.c. to pentobarbital-anesthetized rats induced salivation and leakage of plasma constituents into the skin, muscle, trachea, esophagus and bladder, as measured by Monastral blue B labeling of small blood vessels or by extravasation of Evans blue dye into tissues. These SP effects were inhibited by N-acetyl-neurotensin-(8-13) (Ac-NT-(8-13)) and by CP-96,345, a nonpeptide SP receptor antagonist. Intralumenal injection of Ac-NT-(8-13) or CP-96,345 into the bladder reduced SP-induced leakage of Evans blue dye but not dye leakage into the pawskin, indicating a localised drug action. Ac-NT-(8-13) appears to act directly on discrete sites in skin and in mucous membranes to functionally antagonize the inflammatory effects of SP.

Nitric oxide regulates basal but not capsaicin-, CGRP-, or bile salt-stimulated rabbit esophageal mucosal blood flow

BACKGROUND/AIMS

Esophageal mucosal blood flow is a dynamic phenomenon that is altered by luminal content that probably represents an important intrinsic method of defense. This study investigated the role played by endogenous nitric oxide in the regulation of esophageal mucosal blood flow at rest and in response to luminal capsaicin, a specific stimulant for visceral afferent nerves, as well as calcitonin gene-related peptide, and the bile salt deoxycholate.

METHODS

The L-arginine analog L-NAME was used to block nitric oxide synthesis. Radiolabeled microspheres were used to measure blood flow in a well-characterized rabbit model. Phenylephrine was used to mimic the hemodynamic effects of L-NAME to show the specificity of positive findings.

RESULTS

Administration of L-NAME led to a significant reduction in mucosal blood flow at rest, an effect that was not shared by phenylephrine. The blood flow responses to luminal capsaicin, intra-arterial calcitonin gene-related peptide (CGRP), and luminal deoxycholate, however, were not diminished in the presence of L-NAME.

CONCLUSIONS

Although nitric oxide may play a role in the maintenance of normal resting esophageal mucosal blood flow, the reactive responses to luminal capsaicin, luminal deoxycholate, and intra-arterial CGRP are not nitric oxide dependent.

HCl-induced cell edema in rabbit esophageal epithelium: a bumetanide-sensitive process

BACKGROUND & AIMS

The morphology of acid damage to esophageal epithelium is characterized by marked cell (swelling) edema. This observation suggests that, in the process of acid damage, an increase in osmotic forces develops within the cell that accounts for the increase in cell water. The aim of this study was to document that esophageal cells swell at acidic pH and to explore the nature of the osmolytes and mechanisms responsible for it.

METHODS

Cell edema was assessed in sections of rabbit esophageal epithelium by correlating morphological change with change in tissue wet weight after immersion in acidic solutions for up to 4 hours.

RESULTS

At pH < or = 2 for 2 hours, tissues gained weight and showed cell edema on both light and electron microscopy. In addition to being time- and pH-dependent, cell edema was dependent on bathing solution osmolytes, specifically Na+, K+, and Cl-, and could be inhibited by tissue pretreatment with bumetanide (or ethacrynic acid).

CONCLUSIONS

HCl exposure can spontaneously produce cell edema in esophageal epithelium. The phenomenon is pH- and time-dependent and requires acid stimulation of osmolyte absorption through a bumetanide-sensitive process compatible with an NaK2Cl cotransporter in the epithelial cell membrane.

Effects of oral erythromycin on esophageal motility in patients with noninsulin-dependent diabetes mellitus

Fifteen patients with non-insulin dependent diabetes mellitus (NIDDM) were included in the study. Esophageal motility, including esophageal mean transit time (MTT), residual fraction (RF), and retrograde index (RI), was evaluated and calculated by the radionuclide esophageal transit test (RETT). The baseline study was performed before the oral erythromycin therapy. After a 2-week course treatment, the subjects underwent a second study. The results showed that (A) in the baseline study, 93% (14/15) of NIDDM patients had a longer MTT, 67% (10/15) had a higher RF and 80% (12/15) had a higher RI; and (B) after treatment with erythromycin, 73% (11/15) of the patients had a shorter MTT and a lower RF, and 60% (9/15) of the patients had a lower RI. We conclude that (1) most of the NIDDM patients had esophageal motility disorders and (2) a 2-week oral erythromycin therapy can improve diabetic esophagoparesis, as evaluated by non-invasive REET.

Effect of endoscopic variceal sclerotherapy on esophageal motor functions and gastroesophageal reflux

Sclerotherapy results in significant local complications, both immediate and delayed. This study was designed to examine the esophageal pathophysiology underlying these complications.

METHODS

We prospectively evaluated esophageal transit, motility abnormalities and gastroesophageal reflux (GER) with barium studies and esophageal functional scintigraphy in 24 patients (20 men, 4 women; mean age 33 +/- 12.4 yr) before sclerotherapy (Phase I), after two sessions (Phase II), following variceal eradication (Phase III) and 4 wk later (Phase IV).

RESULTS

Varices were obliterated after 5.6 +/- 1.9 sessions of intravariceal sclerotherapy performed weekly with 1% polidocanol (17.3 ml per session). There was no baseline Phase I dysmotility or reflux. Phase II studies recorded a marked delay of esophageal global and segmental (mid and distal) transit time in 98.2% of patients by scintigraphy and 90% by barium studies. Incoordinate contractions and aperistalsis were observed in 0, 66.7%, 58.3% and 33.8% of patients from Phases I-IV studies, respectively. Barium studies revealed tertiary waves and reverse peristalsis in 0, 50%, and 75% of patients from Phases I-III; strictures were observed in 0, 1, and 3 patients during Phases I-III. GER was detected scintigraphically in 0, 58.3%, 25% and 16.6% during Phases I-IV sequentially. In contrast, barium studies grossly underestimated GER (0, 5% and 15% at phases I-III).

CONCLUSION

There was strong concordance between esophageal symptoms, transit, motility abnormalities and GER (p < 0.05). Variceal eradication (Phases III and IV) was associated with a gradual recovery of esophageal symptoms, ulcers and all abnormal scintigraphic parameters. Sclerosant-induced chemical esophagitis in association with peptic esophagitis due to gross reflux following sclerotherapy possibly can explain the symptoms in most patients.

Pharmacological characterization of two novel and potent 5-HT4 receptor agonists, RS 67333 and RS 67506, in vitro and in vivo

1. The pharmacology of two novel 5-HT4 receptor agonists, RS 67333 (1-(4-amino-5-chloro-2-methoxy-phenyl)-3-[1(n-butyl)-4-piperidinyl]-1- propanone HCl) and RS 67506 (1-(4-amino-5-chloro-2-methoxy-phenyl)-3-[1-(2-methyl sulphonylamino)ethyl-4-piperidinyl]-1-propanone HCl) have been assessed in vitro and in vivo. 2. RS 67333 and RS 67506 exhibited affinities (pKi = 8.7 and 8.8, respectively) for the 5-HT4 binding sites, labelled with [3H]-GR 113808, in guinea-pig striatum. The Hill coefficients from these displacement curves were not significantly different from unity. The compounds exhibited lower affinities (< 6.0) at several other receptors including 5-HT1A, 5-HT1D, 5-HT2A, 5-HT2C, dopamine D1, D2 and muscarinic M1-M3 receptors. However, RS 67333 and RS 67506 did exhibit affinities for the sigma 1 (pKi = 8.9 and 7.9, respectively) and sigma 2 (pKi = 8.0 and 7.3, respectively) binding sites. 3. At the 5-HT4 receptor mediating relaxation of the carbachol-precontracted oesophagus, RS 67333 and RS 67506 acted as potent (pEC50 8.4 and 8.6, respectively), partial agonists (intrinsic activities, with respect to 5-HT were 0.5 and 0.6, respectively) with respect to 5-HT. Relaxant responses to RS 67333 or RS 67506 were surmountably antagonized by GR 11308 (10 nM), with apparent affinities (pKB) of 9.1 and 9.0, respectively. RS 67333 and RS 67506 induced dose-dependent increases in heart rate of the anaesthetized micropig (ED50 4.9 and 5.4 micrograms kg-1, i.v.), with maximal increases of 35 and 47 beats min-1, respectively. 4. RS 67333 and RS 67506, therefore, acted as potent, partial 5-HT4 receptor agonists in vitro and in vivo. These compounds, by virtue of their high potency and selectivity, may have some utility in elucidating the physiological role of 5-HT4 receptors.

Epidermal growth factor attenuates the sclerotherapy-induced biomechanical properties of the oesophagus. An experimental study in minipigs

BACKGROUND

The effect of epidermal growth factor (EGF) on the biomechanical properties of the oesophagus subjected to sclerotherapy was studied in Goettingen minipigs by means of impedance planimetry.

METHODS

Seventeen animals underwent three sessions of weekly endoscopic sclerotherapy. During these 3 weeks and for the subsequent 2 weeks they were treated with either EGF or placebo. After another 3 weeks an impedance planimetric study was done. Ten healthy non-sclerosed pigs were studied as controls. Impedance planimetry was performed by stepwise pressure-induced balloon inflation for analysis of oesophageal cross-sectional area 5 and 10 cm above the gastro-oesophageal junction (GEJ).

RESULTS

Systemic treatment with EGF (total daily dose of 30 micrograms/kg/day, administered subcutaneously) for 3 to 7 days per week combined with a weekly paravenous injection of 20-40 micrograms/kg attenuated the oesophageal damage caused by sclerotherapy, implying less pronounced narrowing 5 cm above and less dilation 10 cm above the GEJ.

CONCLUSION

These observations suggest a potential therapeutic role for EGF in attenuating sclerotherapy-induced oesophageal injury.

Role of nitric oxide in human esophageal circular smooth muscle in vitro

The role of nitric oxide in human esophageal smooth muscle was examined. Immunostaining for constitutive nitric oxide synthase labeled nerve fibers and bundles within longitudinal and circular smooth muscle layers of resected tissue samples. Strips of circular muscle mounted in organ baths exhibited spontaneous contractions and active tone. When exposed to 5-second trains of electric field stimulation at 20 Hz, most strips exhibited intrastimulus "on" and poststimulus "off" contractions. Exposure to a 0.1 mumol/L (or greater) concentration of atropine converted "on" contractions to "on" relaxations and reduced "off" contractions by 63%. Exposure to NG-nitro-L-arginine resulted in concentration-dependent enhancement of "on" contractions and abolition of "off" contractions. Excess L-arginine enhanced the reversal of these effects. Sodium nitroprusside inhibited both spontaneous and evoked contractions. These results suggest that nitric oxide synthesis is a mediator of neural inhibition of human esophageal circular smooth muscle and is necessary for the occurrence of "off" contractions.

RS 39604: a potent, selective and orally active 5-HT4 receptor antagonist

1. Selective antagonism of 5-HT4 receptors may provide therapeutic benefit in certain disorders of the myocardium, alimentary and lower urinary tract. We now report on RS 39604, a novel and selective 5-HT4 receptor antagonist and compare its pharmacological properties with those of SB 204070. 2. In guinea-pig striatal membranes, both RS 39604 and SB 204070 inhibited specific binding of [3H]-GR 113808 in a concentration-dependent manner yielding pKi estimates of 9.1 and 10.9, respectively. RS 39604 displayed a low affinity (pKi < 6.5) for 5-HT1A, 5-HT2C, 5-HT3, alpha 1c, D1, D2, M1, M2, AT1, B1 and opioid mu receptors and moderate affinity for sigma 1, (pKi = 6.8) and sigma 2 (pKi = 7.8) sites. 3. In the rat isolated oesophagus, precontracted with carbachol, RS 39604 (30-300 nM) behaved as a competitive antagonist towards 5-HT-induced relaxation (pA2 = 9.3; Schild slope = 1.0). We and others have shown previously that SB 204070 behaves as an unsurmountable antagonist in this preparation (pA2 approximately 10.5). In the guinea-pig isolated ileal mucosa, RS 39604 (30 nM) antagonized 5-MeOT-induced increase in short-circuit current (pA2 = 9.1). 4. In anaesthetized vagotomized micropigs, RS 39604, administered by the i.v. or intraduodenal (i.duod.) route, produced dose-dependent inhibition of 5-HT-induced tachycardia (ID50 = 4.7 micrograms kg-1, i.v. and 254.5 micrograms kg-1, i.duod). At maximal doses of 30 micrograms kg-1, i.v. and 6 mg kg-1, i.duod., the inhibitory effects of RS 39604 lasted for more than 6 h. In this preparation, SB 204070 was as potent as RS 39604by the i.v. route but was inactive by the intraduodenal route at doses up to 3 mg kg-1.5. In conscious mice, RS 39604, administered by the i.p. or p.o. route, produced dose-depend entinhibition of 5-hydroxytryptophan (5-HTP)-induced diarrhoea (ID50= 81.3 microg kg-1, i.p. and 1.1 mg kg-1,p.o.). In this assay, SB 204070 was inactive by the oral route at doses up to 30 mg kg-1.6. In anaesthetized guinea-pigs, RS 39604 antagonized the contractile effect of 5-HT in the proximal colon by producing parallel, dextral displacement of the dose-response curve to 5-HT. The mean dose ratios to 5-HT at 0.1 mg kg-1, i.v., 1 mg kg-1, i.v. and 10 mg kg-1, i.duod. were 4.6, 30.7 and 10.8,respectively. SB 204070 behaved as an unsurmountable antagonist in this assay.7. In a model of visceral pain in conscious rats, RS 39604 (0.01-1 mg kg-1, i.v.) did not affect colorectal distension-induced increases in arterial pressure whereas morphine (1 mg kg-1, i.v.) produced significant inhibition of the response, implying that 5-HT4 receptors are not involved in nociception in this model.8. The data suggest that RS 39604 is a high affinity and selective 5-HT4 receptor antagonist that is orally active and long-lasting in vivo. It is concluded that RS 39604 may be the preferable probe to use for investigating the physiological and pathophysiological role of 5-HT4 receptors in vivo.

Effect of human gastrin-17 with and without acid suppression on human esophageal motility

The putative role of gastrin for the regulation of esophageal motility is a matter of debate. Accordingly it was the aim of this study a) to examine if physiological postprandial plasma levels of human gastrin-17 (hG-17) can affect esophageal motility, especially the pressure of the lower esophageal sphincter (LESP), and b) to assess the contribution of augmented acid secretion during gastrin infusion. In a first series of experiments postprandial plasma gastrin levels were determined in 8 healthy volunteers following the ingestion of a mixed meal. Gastrin rose from a baseline of 21 +/- 2 pg/ml to 67 +/- 8 pg/ml and returned almost to basal levels within 120 minutes. In a second experimental series the effect of i.v. synthetic human gastrin-17 (hG-17) was studied in 17 volunteers. At a lower dose of 0.75 ng/kg/min hG-17 increased plasma gastrin to 62 +/- 7 pg/ml while a higher dose of 1.5 ng/kg min elicited a supraphysiological increase to 119 +/- 11 pg/ml. Infusion of hG-17 caused a significant increase of the LESP from 19.0 to 25.8 mmHg (p < 0.05, low dose) and from 18.5 mmHg to 23.3 mmHg (p < 0.05, high dose) when compared to the effect of i.v. saline. To exclude effects of augmented acid secretion during hG-17 infusion the experiments were repeated after complete blockade of acid secretion with famotidine 40 mg i.v. After famotidine pretreatment hG-17 caused a similar increase of LESP from 20.1 to 25.9 mmHg (low dose) and from 19.9 to 24.1 mmHg (high dose).(ABSTRACT TRUNCATED AT 250 WORDS)

L-arginine-nitric oxide pathway involvement in the nerve-evoked relaxant responses of the 5-HT precontracted chick isolated upper oesophagus

1. The effects of tetrodotoxin (TTx) and the selective nitric oxide synthase (NOS) inhibitor, NG-nitro-L-arginine methyl ester (L-NAME) on relaxant responses of the 5-HT precontracted chick isolated upper oesophagus to electrical field stimulation (EFS: 25-30V, 5 Hz for 10 s, 1 ms pulse width every 100 s) were investigated; the oesophagus was mounted under 1 g tension in Krebs solution containing 1 microM atropine. Appropriate tissue sections (30 microM thickness) of the chick oesophagus were also processed for NADPH-diaphorase histochemistry. 2. TTx (2 microM) and L-NAME (100-200 microM) inhibited the relaxant responses of the 5-HT precontracted chick oesophagus to EFS in a concentration-dependent manner; L-arginine (0.5-1 mM), but not D-arginine (0.5-1 mM), reversed the inhibition by L-NAME. In the absence of atropine and muscle tone, EFS produced contractile responses of the chick oesophagus that were completely abolished by 1 microM atropine, which also blocked the contractile response to acetylcholine (50 microM). 3. Under light microscopy, NADPH-diaphorase histochemistry confirmed the presence of nitric oxide synthase (NOS)-containing neurones and nerve fibres in the chick oesophagus. 4. The relaxant responses of the 5-HT precontracted chick isolated upper oesophagus to EFS are, therefore, mediated via the stimulation of non-adrenergic non-cholinergic nerves. These are likely to correspond to the histochemically identified NOS-containing neurones involved, presumably, in the synthesis and release of nitric oxide as the relaxant (inhibitory) neurotransmitter in this avian smooth muscle.

Responses of ferret lower esophageal sphincter to 5-hydroxytryptamine: pathways and receptor subtypes

In urethananesthetized ferrets, basal lower esophageal sphincter pressure (LESP) was unaffected by the 5-hydroxytryptamine3 (5-HT3) receptor antagonist granisetron (0.5 mg/kg) or by greater splanchnic nerve section (GSX), but increased after bilateral vagotomy. Peripheral vagal nerve stimulation caused LES relaxation, often followed by a brief contraction and a prolonged inhibition of LESP. Close intra-arterial injection of 5-HT (5-100 micrograms) had a biphasic effect on LESP, with a brief drop followed by a prolonged increase. Granisetron (0.5 mg/kg i.v.) abolished the initial relaxation and revealed an earlier peak of excitation. This was not influenced by subsequent vagotomy and GSX. In a series of eight additional experiments (series 2), granisetron was given after vagotomy and GSX. In series 2, 5-HT-induced relaxation was unaffected by vagotomy but was significantly reduced after GSX and was further reduced after granisetron, indicating that 5-HT3 receptor mechanisms may lie on a sympathetic neural pathway. Vagotomy had no effect on the excitatory component. GSX had no effect on the amplitude of excitation, but reduced its latency. Granisetron had no further effect on excitation in series 2. In a separate series of 13 experiments (series 3), the excitatory component of the LES response to 5-HT was abolished by ketanserin (2.5 mg/kg i.v.) , after which only relaxation occurred. Both 5-HT2 and 5-HT3 antagonists in combination abolished all effects of 5-HT on LESP. Atropine (400 micrograms/kg i.v., n = 7) had no effect on 5-HT-induced LES responses.(ABSTRACT TRUNCATED AT 250 WORDS)

Free radical scavengers prevent reflux esophagitis in rats

Free radical damage in reflux esophagitis of rats induced by 24-hr duodenojejunal ligation was studied. Oxygen free radicals were selectively blocked. Groups were: sham operation, reflux, reflux + superoxide dismutase (SOD), catalase, dimethylthiourea, allopurinol, and inactivated SOD or inactivated catalase alone or in the combination SOD + catalase or SOD + catalase + dimethylthiourea + allopurinol. Macroscopic esophagitis was inhibited only by SOD, alone or in combination with other agents. Esophageal mucosal lipid peroxidation was 10-fold increased in the reflux group compared to the sham group (P < 0.05). This response was damped by SOD > catalase (P < 0.05) but not by the inactivated enzymes, dimethylthiourea or allopurinol. SOD + catalase showed no significant improvement on SOD alone. Total inhibition of lipid peroxidation was achieved by combining all scavengers. Total glutathione (GSH) in the esophageal mucosa was stimulated by reflux. This response was inhibited by scavengers equivalent to their efficacy in preventing lipid peroxidation. It is concluded that reflux esophagitis is associated with free radical release with O2- being the main source. Free radicals appear to stimulate GSH production in this prolonged oxidative stress.

Vagal nerve stimulation of the guinea-pig oesophagus

Vagal nerve stimulation of the isolated guinea-pig oesophagus resulted in a triphasic contractile response which was abolished by tetrodotoxin. The mechanisms for each of the three responses were investigated. The first response was abolished by the neuromuscular blocking drug, tubocurarine, and was unaffected by atropine. The second response to vagal nerve stimulation was abolished by the ganglion blocking drug, hexamethonium, and by tubocurarine at a higher concentration than that required to block the first response. The second response was also abolished by atropine and was enhanced by physostigmine. It was concluded that this response was due to preganglionic stimulation of smooth muscle. omega-Conotoxin GVIA selectively inhibited the third response. This response was resistant to the neuromuscular and ganglion blocking drugs yet was abolished by atropine and was enhanced by physostigmine. This implicates the involvement of cholinergic neurones activated independently of nicotinic ganglionic receptors. The third response was also selectively abolished by capsaicin and enhanced by thiorphan. Contractile responses resulting from exogenous substance P were abolished by atropine and tetrodotoxin and enhanced by physostigmine. These findings suggest that the third response may be mediated by the action of a substance P-like neuropeptide released from sensory nerve endings which subsequently activate cholinergic neurones.

Effect of topical oesophageal acidification on human salivary and oesophageal alkali secretion

Recent human studies suggest that oesophageal HCO3- secretion, in conjunction with salivary HCO3- secretion and secondary oesophageal peristalsis, is important for the protection of oesophageal mucosa from refluxed gastric contents. This study evaluated simultaneously the responsiveness of oesophageal and salivary HCO3- secretion to oesophageal acidification in eight healthy subjects. A 10 cm segment of oesophagus was perfused at a constant rate of 5 ml/min with a specially designed tube assembly. Saline was used initially, and then 10 mM and 100 mM HCl. The perfusates contained 3H-polyethylene glycol (PEG) as a concentration marker to determine volumes. Corrections were applied for a small degree of contamination by swallowed saliva and refluxed gastric alkali. Oesophageal perfusion with 10 mM HCl did not cause symptoms (nausea and heartburn), but tripled the oesophageal HCO3- output from a baseline of 51 mumol/10 cm/10 min (p = 0.021), while doubling the rate of salivary HCO3- secretion from a median basal value of 140 mumol/10 min (p = 0.021). Oesophageal perfusion with 100 mM HCl was associated with symptoms of nausea and heartburn in all subjects. The median oesophageal HCO3- output increased 32 fold to 1659 mumol/10 cm/10 min (interquartile range 569 to 3373; p = 0.036), and salivary HCO3- secretion approximately tripled from basal values (p = 0.036). In conclusion, oesophageal acidification stimulates both salivary and oesophageal HCO3- secretion, responses which may be protective to the oesophageal epithelium.

Effect of body position on oesophageal and gastric pressures in the anaesthetised dog

The effect of body position on lower oesophageal sphincter pressure (LOSP), gastric pressure and barrier pressure (BrP) was investigated in 40 dogs anaesthetised for neutering procedures. The dogs were placed in lateral recumbency followed by dorsal recumbency (group 1) or vice versa (group 2). LOSP decreased significantly in the animals which were positioned initially in lateral recumbency, when they were then placed in dorsal recumbency, while those initially positioned in dorsal recumbency showed no significant change in their LOSP or BrP when their position was altered to lateral recumbency. When the data from both groups were pooled, LOSP and BrP were significantly lower when the dogs were in dorsal compared to lateral recumbency (P < 0.05).

Effect of naproxen on gastroesophageal reflux and esophageal function: a randomized, double-blind, placebo-controlled study

OBJECTIVES

Gastrointestinal symptoms, particularly pyrosis, complicate nonsteroidal anti-inflammatory drug (NSAID) use. NSAIDs cause esophageal injury, and H2 blockers are often prescribed for, and successfully control, NSAID-related symptoms. To determine whether NSAIDs can induce gastroesophageal reflux, we studied the effect of a commonly used NSAID, naproxen, on reflux parameters and esophageal function.

METHODS

Nine healthy volunteers (five males, four females, age 23-34 yr) were studied. After basal measurements were taken, the subjects randomly received naproxen 500 mg p.o. b.i.d. or placebo for 1 wk. On day 6, the subjects underwent esophageal manometry with a water-perfused system and Dent sleeve. Body pressures, contraction velocity, and duration of contraction were recorded in the distal 7 cm of the esophagus. The lower esophageal sphincter pressure (LESP) and number of transient relaxations (TLESRs) were monitored. This was followed by 24-h pH monitoring. The subjects then crossed over to the other drug after a minimum 14-day wash-out period.

RESULTS

No subject experienced any GI symptoms during the study. One subject developed reflux-induced symptoms a few months after completing the study and was excluded from the analysis. The total fraction of time (pH < 4) was 4.9 +/- 1.0% in the basal state, 5.5 +/- 1.4% on placebo, and 5.4 +/- 1.5% on naproxen. These differences were not significant. The number of reflux episodes and the esophageal clearance time were not affected by naproxen. The LESP in the basal state was 32.1 +/- 5.6 mm Hg, 32.3 +/- 4.2 mm Hg on placebo, and 29.9 +/- 3.3 mm Hg on naproxen (p = NS). The number of TLESRs per 30 minutes in the basal state was 3.5 +/- 0.9, 4.6 +/- 1.2 on placebo, and 5.8 +/- 1.0 on naproxen (p = NS). The speed and duration of contractions were not affected by naproxen. The excluded subject had marked basal reflux (total fraction of time pH < 4 = 10.7%), low LESP (8 mm Hg), and a marked increase in reflux on naproxen (total fraction of time pH < 4 = 53%).

CONCLUSIONS

Naproxen did not induce reflux in normal subjects, although reflux did increase in some subjects. Naproxen had no significant effect on motility parameters. Our data suggest that NSAIDs do not impair the anti-reflux barrier or induce reflux. Pyrosis experienced during NSAID use may not arise from the esophagus or may reflect altered esophageal sensitivity. A single subject with decreased LESP and asymptomatic increased acid exposure in the basal state had a marked increase in reflux on naproxen. This person subsequently developed symptomatic gastroesophageal reflux. The effect of NSAIDs on individuals with a propensity to reflux deserves further study.

K+ channel opening mediates hyperpolarizations by nitric oxide donors and IJPs in opossum esophagus

The ionic mechanisms by which nitric oxide (NO) or a related compound mediates the inhibitory junction potentials (IJPs) of the opossum esophageal circular smooth muscle were studied using microelectrodes and double sucrose gap. The NO donors, 3-morpholino-sydnonimine hydrochloride and sodium nitroprusside, induced 15- to 20-mV hyperpolarizations that reversed near the potassium equilibrium potential as did the IJPs. They inhibited the IJPs and decreased electrotonic potentials (increased conductance) even during restoration of the resting membrane potential by application of depolarizing current. Quinine was more efficacious than apamin in inhibiting the IJPs or NO donor hyperpolarizations, whereas the other K+ channel blockers tested (tetraethylammonium, charybdotoxin, 4-aminopyridine, Cs+, and glibenclamide) were without effect. Glibenclamide abolished the hyperpolarizing effects of the K+ channel opener BRL-34915. Low Cl- Krebs (isethionate substitutions) caused hyperpolarizations, increased electrotonic potentials, and reduced IJPs. The neural blockers, tetrodotoxin, omega-conotoxin GVIA, and N omega-nitro-L-arginine methyl ester, inhibited IJPs but not the responses to NO donors, indicating a postjunctional effect. Methylene blue and cystamine, soluble guanylate cyclase inhibitors, suppressed IJPs and responses to NO donors. We conclude that NO mediates esophageal IJPs, which depend on guanosine 3',5'-cyclic monophosphate elevation and activation of quinine- and apamin-sensitive K+ channels.

Effects of recombinant human hemoglobin on motor functions of the opossum esophagus

Chemically altered hemoglobins are being investigated as blood substitutes. They may affect numerous biological processes since free hemoglobin binds nitric oxide (NO). Nitric oxide is a neural mediator of relaxation of the lower esophageal sphincter (LES) and esophageal peristalsis. We hypothesize that recombinant human hemoglobin (rHb1.1) alters esophageal motor function by scavenging NO. Contraction of transverse muscle strips from the opossum esophagus and LES was monitored. Transmembrane potential differences of circular smooth muscle from the esophagus were recorded using glass microelectrodes. Intrinsic esophageal nerves were stimulated electrically. Esophageal manometries were performed with a low-compliance perfused-catheter system. The activity of the enzyme NO synthase was determined with the citrulline assay. Recombinant hemoglobin diminished nerve-induced relaxation of LES muscle but did not alter LES tone. Circular esophageal muscle responded to nerve stimulation with an inhibitory junction potential and a mechanical off response. Recombinant hemoglobin diminished the inhibitory junction potential and shortened the latency of the off response. It increased the velocity of esophageal peristalsis, decreased the amplitudes of these contractions and diminished LES relaxation. Cyanomethemoglobin had little effect on nerve- or swallow-induced responses. Hemoglobin did not inhibit the activity of NO synthase. Recombinant human hemoglobin appears to alter esophageal motor function by scavenging NO.

Late effects of radiation therapy on the gastrointestinal tract

Late gastrointestinal complications of radiation therapy have been recognized but not extensively studied. In this paper, the late effects of radiation on three gastrointestinal sites, the esophagus, the stomach, and the bowel, are described. Esophageal dysmotility and benign stricture following esophageal irradiation are predominantly a result of damage to the esophageal wall, although mucosal ulcerations also may persist following high-dose radiation. The major late morbidity following gastric irradiation is gastric ulceration caused by mucosal destruction. Late radiation injury to the bowel, which may result in bleeding, frequency, fistula formation, and, particularly in small bowel, obstruction, is caused by damage to the entire thickness of the bowel wall, and predisposing factors have been identified. For each site a description of the pathogenesis, clinical findings, and present management is offered. Simple and reproducible endpoint scales for late toxicity measurement were developed and are presented for each of the three gastrointestinal organs. Factors important in analyzing late complications and future considerations in evaluation and management of radiation-related gastrointestinal injury are discussed.

Effect of HCl on transmembrane potentials and intracellular pH in rabbit esophageal epithelium

BACKGROUND/AIMS

Acidification of the basolateral membrane by adding HCl to the serosal solution of esophageal epithelium leads to more necrosis than acidification of the apical membrane by adding HCl to the luminal solution. The aim of this study was to examine the mechanism for this difference.

METHODS

The effect of low extracellular pH (pHo) (HCl) on intracellular pH (pHi) and transmembrane potentials was examined in rabbit esophageal cells by impalement with intracellular microelectrodes.

RESULTS

Lowering luminal pH to 3.0 had no effect on membrane voltage and/or pHi in either luminally or serosally impaled cells, although a decline in both parameters occurred at pH 1.5 in luminally impaled cells. In contrast, lowering serosal pH from 7.4 to 3.0 progressively reduced membrane voltage and/or pHi. Membrane depolarization at low pHo was inhibited by a high-potassium solution or barium and mimicked by lowering pHi (gassing with CO2) at neutral pHo.

CONCLUSIONS

Basolateral, but not apical, membranes of esophageal epithelial cells are highly permeable to H+, accounting for the greater susceptibility to damage from exposure to serosal than luminal acid. Membrane depolarization at low pHo is mediated by low pHi through inhibition of basolateral membrane K+ conductance.

Assessment of apoptosis in oesophageal carcinoma preoperatively treated by chemotherapy and radiotherapy

Apoptosis, programmed cell death, was immunohistochemically determined in 55 samples of oesophageal squamous cell carcinoma using the BM1 Mab. Sections from patients not treated (group 1, n = 12) or preoperatively treated by chemotherapy (group 2, n = 11), radiation (group 3, n = 13) or both (group 4, n = 8), and 11 additional cases of high-grade dysplasia or early cancer were examined. Most of the apoptotic cells were BM1-positive and checked by TUNEL proved to be nick end positive. They accounted for 7 (11%), 19 (29%), 21 (32%) and 26 (38%) cells per field in those 4 groups respectively. Chemotherapy and/or radiation significantly increased the number of apoptotic cells as compared to controls (p = 0.029 and p = 0.029, respectively). To assess the implications of the oncogene expression in the apoptotic pathway, additional section stained with bcl2 and p53 were negative for bcl2 and were positive for p53 in 16 samples (37%). Overall, positive cases for p53 mutation showed a significantly decreased incidence of apoptotic cells (p = 0.03). These results suggest that in situ assessment of apoptotic response better correlates to the apoptosis induced by radiation than that by chemotherapy, that abnormalities of the p53 protein decrease the apoptotic response in oesophageal carcinoma, and that immunohistochemical analysis of p53 protein helps to determine the sensitivity to these anticancer agents.

In vivo and in vitro influence of human recombinant hemoglobin on esophageal function

The purpose of the present investigation was to examine the influence of a nitric oxide scavenger, hemoglobin (Hb), on esophageal function. Intraluminal pressures of anesthetized opossums were recorded from lower esophageal sphincter (LES) and 1, 5, and 9 cm above the LES. The influence of a representative Hb-based oxygen carrier was examined on swallowing-induced esophageal peristalsis and LES relaxation. In in vitro studies, LES relaxation and esophageal peristaltic contractions were induced by the activation of nonadrenergic noncholinergic (NANC) neurons by electrical field stimulation (EFS). Hb caused significant impairment in swallowing- and EFS-induced LES relaxation and a significant increase in the speed of esophageal peristalsis. In some experiments, swallowing caused simultaneous contractions in the esophagus following Hb administration. Although Hb completely blocked LES relaxation by NO and significantly attenuated that by NANC nerve stimulation, it had no significant effect on isoproterenol-induced LES relaxations. The data support the role of NO in LES relaxation and esophageal peristalsis. This esophageal model may be important in understanding the influence of NO inhibitors and scavengers in gastrointestinal motility.