Diminished Retention of Food in the Proximal Stomach Correlates with Increased Acidic Reflux in Patients with Gastroesophageal Reflux Disease and Dyspeptic Symptoms

Herculano, José Ruver L; Troncon, L E A; Aprile, Lilian Rose Otoboni; Moraes, Éder Rezende; Secaf, Marie; Onofre, Pedro H. C.; Dantas, Roberto Oliveira; Oliveira, Ricardo Brandt de

doi:10.1023/b:ddas.0000030084.01927.a8

Cited by 32 publications

(49 citation statements)

References 36 publications

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“…This autonomic improvement may act not only in the EGJ but also in the stomach to reduce tLESR. Disturbed postprandial meal distribution in the stomach is associated with increased tLESR in children fed with high volume and osmolality meal (25), and GERD patients have reduced proximal stomach meal retention (12). It is possible that autonomic function improvement in GERD would counteract motor derangements like the last one.…”

Section: Discussionmentioning

confidence: 99%

Inspiratory muscle training improves antireflux barrier in GERD patients

Souza

Lima

Martins

et al. 2013

American Journal of Physiology-Gastrointestinal and Liver Physi

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Nobre e Souza MÂ, Lima MJ, Martins GB, Nobre RA, Souza MH, de Oliveira RB, dos Santos AA. Inspiratory muscle training improves antireflux barrier in GERD patients. Am J Physiol Gastrointest Liver Physiol 305: G862-G867, 2013. First published October 10, 2013 doi:10.1152/ajpgi.00054.2013.-The crural diaphragm (CD) is an essential component of the esophagogastric junction (EGJ), and inspiratory exercises may modify its function. This study's goal is to verify if inspiratory muscle training (IMT) improves EGJ motility and gastroesophageal reflux (GER). Twelve GER disease [GERD; 7 males, 20 -47 yr, 9 esophagitis, and 3 nonerosive reflex disease (NERD)] and 7 healthy volunteers (3 males, 20 -41 yr) performed esophageal pH monitoring, manometry, and heart rate variability (HRV) studies. A 6-cm sleeve catheter measured average EGJ pressure during resting, peak inspiratory EGJ pressures during sinus arrhythmia maneuver (SAM) and inhalations under 17-, 35-, and 70-cmH2O loads (TH maneuvers), and along 1 h after a meal. GERD patients entered a 5-days-a-week IMT program. One author scored heartburn and regurgitation before and after IMT. IMT increased average EGJ pressure (19.7 Ϯ 2.4 vs. 29.5 Ϯ 2.1 mmHg; P Ͻ 0.001) and inspiratory EGJ pressure during SAM (89.6 Ϯ 7.6 vs. 125.6 Ϯ 13.3 mmHg; P ϭ 0.001) and during TH maneuvers. The EGJ-pressure gain across 35-and 70-cmH2O loads was lower for GERD volunteers. The number and cumulative duration of the transient lower esophageal sphincter relaxations decreased after IMT. Proximal progression of GER decreased after IMT but not the distal acid exposure. Low-frequency power increased after IMT and the higher its increment the lower the increment of supine acid exposure. IMT decreased heartburn and regurgitation scores. In conclusion, IMT improved EGJ pressure, reduced GER proximal progression, and reduced GERD symptoms. Some GERD patients have a CD failure, and IMT may prove beneficial as a GERD add-on treatment. crural diaphragm; GERD; lower esophageal sphincter; muscle training

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Section: Discussionmentioning

confidence: 99%

Inspiratory muscle training improves antireflux barrier in GERD patients

Souza

Lima

Martins

et al. 2013

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…A number of studies have also implicated delayed gastric emptying as a possible contributing factor which promotes acidic GER. 12,24 While PPIs such as omeprazole significantly decrease both gastric acid secretion and acid reflux, neither is completely inhibited by the PPI therapy and any delay in gastric emptying could still be a negative factor. In view of the very common use of PPIs to treat GERD symptoms, our results may also have important therapeutic implications for this patient group.…”

Section: -4mentioning

confidence: 99%

“…7,11 Exacerbation of this abnormality may possibly contribute to causing or worsening GER and increase the prevalence of dyspeptic symptoms commonly reported by this patient group. 7,[12][13][14] Drugs, which improve gastric emptying, can improve GERD symptoms, mucosal healing, and increase the efficacy of the antisecretory medications in chronic GERD management. 15,16 Tegaserod is a peripherally acting partial 5HT 4 -receptor agonist, which is approved for the treatment of women with irritable bowel syndrome with constipation (IBS-C) and for the treatment of men and women with chronic constipation.…”

Section: Introductionmentioning

confidence: 99%

Omeprazole delays gastric emptying in healthy volunteers: an effect prevented by tegaserod

Tougas

Earnest

Chen

et al. 2005

Aliment Pharmacol Ther

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SUMMARYBackground: Proton-pump inhibitors effectively suppress stomach acidity. They are widely used for treating gastro-oesophageal reflux disease and related conditions. While generally safe, omeprazole and other proton-pump inhibitors can delay gastric emptying. Aim: To test the hypothesis that tegaserod can normalize or prevent omeprazole-induced delay in gastric emptying.Methods: This was a randomized, double-blind, placebocontrolled, parallel group study in 40 healthy male volunteers. After informed consent and screening, qualified volunteers were treated with unblinded omeprazole 20 mg b.d. and either blinded tegaserod 6 mg

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“…In a study correlating gastric emptying and oesophageal pH impedance, Emerenziani et al [11] showed that the slower the emptying, the higher the pH and proximal extent of the refluxate. On the other hand, studies evaluating the intragastric distribution of food in patients with GOR disease and dyspepsia showed a significant negative correlation between the proximal gastric retention and the number of acidic reflux episodes, whereas total gastric emptying was similar in patients and controls [12]. In addition, the acquisition period is not well defined for the GOR studies, further complicating the interpretation.…”

Section: Discussionmentioning

confidence: 98%

Effects of the frame acquisition rate on the sensitivity of gastro-oesophageal reflux scintigraphy

Codreanu

Chamroonrat²,

Edwards³

et al. 2013

BJR

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Objective: To compare the sensitivity of gastro-oesophageal reflux (GOR) scintigraphy at 5-s and 60-s frame acquisition rates.Methods: GOR scintigraphy of 50 subjects (1 month-20 years old, mean 42 months) were analysed concurrently using 5-s and 60-s acquisition frames. Reflux episodes were graded as low if activity was detected in the distal half of the oesophagus and high if activity was detected in its upper half or in the oral cavity. For comparison purposes, detected GOR in any number of 5-s frames corresponding to one 60-s frame was counted as one episode.Results: A total of 679 episodes of GOR to the upper oesophagus were counted using a 5-s acquisition technique. Only 183 of such episodes were detected on 60-s acquisition images. To the lower oesophagus, a total of 1749 GOR episodes were detected using a 5-s acquisition technique and only 1045 episodes using 60-s acquisition frames (these also included the high-level GOR on 5-s frames counted as low level on 60-s acquisition frames). 10 patients had high-level GOR episodes that were detected only using a 5-s acquisition technique, leading to a different diagnosis in these patients. No correlation between the number of reflux episodes and the gastric emptying rates was noted. Conclusion:The 5-s frame acquisition technique is more sensitive than the 60-s frame acquisition technique for detecting both highand low-level GOR. Advances in knowledge:Brief GOR episodes with a relatively low number of radioactive counts are frequently indistinguishable from intense background activity on 60-s acquisition frames.

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Diminished Retention of Food in the Proximal Stomach Correlates with Increased Acidic Reflux in Patients with Gastroesophageal Reflux Disease and Dyspeptic Symptoms

Cited by 32 publications

References 36 publications

Inspiratory muscle training improves antireflux barrier in GERD patients

Inspiratory muscle training improves antireflux barrier in GERD patients

Omeprazole delays gastric emptying in healthy volunteers: an effect prevented by tegaserod

Effects of the frame acquisition rate on the sensitivity of gastro-oesophageal reflux scintigraphy

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