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Effects of cerulein on esophageal motor activity and L.E.S. pressure in achalasia

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Abstract

Several authors recently proposed the use of cerulein, a decapeptide extracted from the skin of various amphibians, for the diagnosis of gastroenterological afflictions. The demonstration that the 4 C-terminal amino acid sequence of cerulein is the same as that of the active tetrapeptide of gastrin and cholecystokinin led us to the study of cerulein's effects on esophageal body motility and on the lower esophageal sphincter (L.E.S.) pressure in achalasic patients, in order to improve the traditional manometric examination. In 18 achalasic patients, we observed that the intravenous infusion of 5 ng/kg per min of cerulein caused L.E.S. pressure to fall to zero in 2 minutes; pressure returned to normal in about 30 minutes. During the examination, we observed the restoration of post-deglutition L.E.S. relaxation, and an increase of 50% in the amplitude of esophageal body motor waves. However, the capacity of cerulein to induce such modifications in motility greatly decreased in patients with peptic or neoplastic stenosis of the distal third of the esophagus. These considerations permit the assumption that the action of cerulein on L.E.S. motility should not be ascribed to vagal stimulation of the nervous plexuses, but to a direct action of the hormone on the CCK-PZ receptors of the esophageal smooth muscle fibers.

Résumé

Plusieurs auteurs ont proposé récemment d'employer la céruléine, un décapeptide, extrait de la peau de divers amphibiens, pour porter le diagnostic d'affections gastro-entérologiques.

La constatation que la séquence amino-acide terminale de la céruléine est identique à celle du tétrapeptide actif de la gastrine et de la cholécystokinine, nous a conduit à étudier son effet sur la motricité de l'oesophage et de son sphincter inférieur, chez les malades atteints d'achalasie oesophagienne de manière à améliorer l'étude manométrique classique.

Chez 18 malades, nous avons constaté que l'injection intra-veineuse de 5 ng/kg/mn de céruléine entraîne la chute de la pression jusqu'à zéro en 2 minutes, puis le retour à la pression normale en 30 minutes environ. Pendant l'exploration, le relâchement du sphincter, secondaire à la déglutition se rétablit cependant que les contractions péristaltiques au niveau de l'oesophage augmentent de 50%. En revanche ces propriétés de la céruléine sont considérablement diminuées quand le tiers inférieur de l'oesophage est le siège d'un ulcère peptique ou d'un cancer.

Ces considérations permettent de penser que l'action de la céruléine sur le sphincter inférieur de l'oesophage ne peut être attribuée à une stimulation vagale des plexus nerveux mais à une action hormonale s'exercant sur le muscle oesophagien.

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Correspondence to Maurizio Cardi M.D..

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Fegiz, G., Paolini, A., Annessi, M. et al. Effects of cerulein on esophageal motor activity and L.E.S. pressure in achalasia. World J. Surg. 6, 418–421 (1982). https://doi.org/10.1007/BF01657670

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Keywords

  • Achalasia
  • Lower Esophageal Sphincter
  • Vagal Stimulation
  • Cholecystokinin
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