Background & Aims: A unique motor response to sustained esophageal distension, repetitive antegrade contractions (RACs), is observed using functional luminal imaging probe (FLIP) panometry. However, physiologic mechanisms related to this response are unexplored. This study aimed to evaluate the impact of cholinergic inhibition with atropine on the esophageal contractile response to sustained distention, including RACs, among healthy volunteers. Methods: 8 asymptomatic volunteers (ages 22-45) were evaluated in a crossover study design with 16-cm FLIP positioned across the esophagogastric junction and distal esophagus during sedated upper endoscopy. The FLIP study involving stepwise volumetric distension was performed twice in each subject, at baseline and again after atropine (15 mcg/kg) was administered intravenously. FLIP panometry was analyzed to assess the contractile response to distension. Results: Antegrade contractions, lumen-occluding contractions, and a RAC pattern were observed in 8/8, 8/8, and 7/8(88%) subjects, respectively, at baseline and in 5/8 (63%), 2/8 (25%) and 2/8 (25%) subjects after atropine. The rate of contractions in the RAC pattern was similar (6-7 contractions per minute) before and after atropine. Compared with the baseline study, distension-induced contractility was triggered at higher fill volumes after atropine. FLIP pressures were lower in response to volumetric filling after atropine than at baseline. Conclusions: The vigor and triggering of the esophageal contractile response to distension is reduced by cholinergic inhibition in asymptomatic controls. The observation that the rate of contractions did not change when patients developed repetitive contractile responses suggests that this rate is not modified by cholinergic inhibition once contractility is triggered.

中文翻译：

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重复顺行收缩：胆碱能影响调节持续食管扩张的新反应


背景和目的：使用功能性管腔成像探针（FLIP）全景测量法观察对持续食管扩张、重复顺行收缩（RAC）的独特运动反应。然而，与这种反应相关的生理机制尚未被探索。本研究旨在评估阿托品胆碱能抑制对健康志愿者持续扩张（包括 RAC）食管收缩反应的影响。方法：采用交叉研究设计对 8 名无症状志愿者（22-45 岁）进行评估，在镇静上消化道内窥镜检查期间将 16 厘米 FLIP 放置在食管胃交界处和远端食管上。涉及逐步容积扩张的 FLIP 研究在每个受试者中进行了两次，一次是在基线，另一次是在静脉注射阿托品（15 mcg/kg）后进行。分析 FLIP 全景测量法以评估对扩张的收缩反应。结果：在基线时，分别有 8/8、8/8 和 7/8 (88%) 受试者观察到顺行收缩、管腔闭塞收缩和 RAC 模式，在 5/8 (63%)、2 /8 (25%) 和 2/8 (25%) 受试者服用阿托品后。在阿托品注射前后，RAC 模式中的收缩率相似（每分钟 6-7 次收缩）。与基线研究相比，阿托品后填充体积较高时会触发扩张诱导的收缩性。阿托品后容量充盈反应的 FLIP 压力低于基线。结论：在无症状对照中，胆碱能抑制可降低食管对扩张的收缩反应的强度和触发。 当患者出现重复的收缩反应时，收缩速率没有改变，这一观察结果表明，一旦触发收缩性，该速率就不会因胆碱能抑制而改变。