Effect of atropine on esophageal motor function in humans

Abstract

In this study, the authors used a high-fidelity manometric recording system to quantitate the effects of atropine on lower esophageal sphincter (LES) pressure and primary peristalsis (1° P). A sleeve sensor recorded LES pressure, and seven recording orifices spaced at 3-cm intervals registered motor activity in the esophageal body. Five randomized manometric studies were done in each of five normal subjects. LES pressure and 1° P with wet swallows were recorded for 30 min before and 70 min after intravenous injection of saline or atropine, 3, 6, 12, and 24 μg/kg. The authors also studied the effect of atropine on LES pressure in five additional subjects, four dogs, four opossums, and six monkeys. In humans, saline and 3 μg/kg atropine caused no significant change in pulse rate, LES pressure, or the incidence of complete peristaltic sequences. The 6, 12, and 24 μg/kg atropine doses caused significant inhibition of LES pressure and the incidence of intact 1° P. Only the 12 and 24 μg/kg doses increased pulse rate. When 1° P occurred in the smooth muscle portion of the esophagus, its appearance in the proximal portion of the smooth muscle segment was delayed for several seconds. The amplitude of 1° P was decreased 30-60% in the smooth muscle segment, but 1° P was not affected in the proximal striated muscle esophageal segment. Atropine reduced canine LES pressure substantially but caused no change in opossums or monkeys. It is concluded that (1) basal LES tone in humans and dogs, unlike that of the opossum and monkey, is partially generated by cholinergic neural input, (2) cholinergic nerves elicit 1° P in human esophageal smooth muscle, and (3) species variation exists in esophageal responses to atropine.