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Anticholinergic drugs in a patient with Z-E syndrome were only temporarily successful in suppressing gastric hypersecretion and producing symptomatic relief. After escape from control with propantheline bromide, glycopyrrolate was only partially successful in suppressing basal acid secretion. Eventually, complete escape from anticholinergic control occurred with a recurrence of significant gastric hypersecretion and the development of severe peptic esophagitis, necessitating total gastrectomy.

Mechanical events and membrane potential changes in response to evoked swallows and cervical vagal stimulation (10 and 40 Hz) were recorded in anesthetized opossums. Miniature strain-gauge transducers monitored the mechanical activity of the two layers. A suction electrode recorded from the intact esophagus, from a proximally based pedicle flap of longitudinal muscle (LM), and from circular muscle (CM). The onset of swallowing was marked by the onset of mylohyoid activity. During swallows LM contraction preceded CM contraction and was of longer duration. The latencies of LM and CM contraction were 1,980 +/- 38 and 2,250 +/- 101 ms, respectively. The durations of contraction of LM and CM were 5,590 +/- 260 and 3,330 +/- 67 ms, respectively. LM showed no hyperpolarization but showed depolarization and spike burst. The CM showed prompt hyperpolarization followed by depolarization and spike burst. Responses to vagal stimulation were qualitatively similar to swallows. The different components of the responses were quantitatively modified by changes in stimulus frequency. These studies show that, during peristalsis in response to swallows and vagal stimulation, 1) LM contraction occurs before CM and is of longer duration, and 2) unlike CM, LM does not hyperpolarize prior to depolarization.

Infusions of verapamil (V) and sodium nitroprusside (NP) caused dose-dependent reductions in the lower esophageal sphincter pressure (LESP) in anesthetized opossums. Verapamil caused a gradual fall during the infusion and a gradual recovery upon cessation of the infusion. On the other hand, NP caused a prompt reduction and a prompt recovery. Both the agents also caused a fall in arterial blood pressure, but the fall in LESP was not related to the fall in the blood pressure. Both the agents antagonized the tonic and the phasic components of the LESP and, in large doses, both drugs almost abolished the LESP. Esophageal contractions were also antagonized by both agents, although verapamil was more effective than nitroprusside in this regard. These studies show that phasic and tonic components of LESP are not related to distinctive verapamil and nitroprusside sensitive calcium activation systems. Moreover, the V- and NP-sensitive calcium activation systems may lie in series rather than parallel.

We examined the mechanical activity of the longitudinal and circular muscles of the esophagus at three different levels (9, 5, and 1 cm above the lower esophageal sphincter) during peristalsis induced by swallows or vagal stimulation in anesthetized opossums with miniature strain gauges applied in the axis of muscle fibers. The onset of longitudinal muscle contraction occurred in an aboral sequence with swallows but simultaneously with vagal stimulation. The speed of longitudinal muscle activation with swallows was 7.6 +/- 1.7 cm/s. Circular muscle contraction occurred in an aboral sequence with vagal stimulation and swallowing with speeds of 4.1 +/- 0.8 and 2.3 +/- 0.1 cm/s, respectively. Longitudinal muscle contracted before the circular muscle at all sites. The duration of longitudinal muscle contraction increased aborally (P less than 0.05) with swallowing or vagal stimulation. These studies show that 1) during swallowing, esophageal longitudinal and circular smooth muscle contract in a sequential fashion, 2) the longitudinal muscle sequential contraction is due to central mechanisms, whereas circular muscle sequential contraction may be due to both central and peripheral mechanisms, and 3) peripheral neuromuscular mechanisms produce regional differences in the duration of longitudinal muscle contraction.

Studies were performed in anesthetized opossums to investigate the nature of vagal-stimulated sphincter relaxation, which is resistant to antagonism by a combination of hexamethonium and atropine. The sphincter pressures were measured with water-filled and continuously perfused catheters anchored in the lower esophageal sphincter. Neither increase in the doses of hexamethonium and atropine nor addition of diphenhydramine further modified the vagal response. However, administration of 5-methoxydimethyltryptamine in the presence of hexamethonium and atropine abolished vagally stimulated sphincter relaxation. In animals pretreated with parachlorophenylalanine, addition of atropine and hexamethonium also abolished vagally stimulated sphincter relaxation. In the experiments in which lower esophageal sphincter relaxation on vagal stimulation was abolished, the local stimulation of intramural neurons still produced normal lower esophageal sphincter relaxation. These studies suggest that 5-hydroxytryptamine may participate in the vagal inhibitory pathway to the lower esophageal sphincter.