Effect of cold stress on postprandial lower esophageal sphincter competence and gastroesophageal reflux in healthy subjects

Abstract

The effect of cold stress on postprandial lower esophageal sphincter competence and gastroesophageal reflux was investigated in nine healthy subjects. All subjects were studied twice in a randomized order according to a common protocol: 30 min after completion of a 700-kcal meal they put their nondominant hand in water either at 37 degrees C (control stimulus) or at 4 degrees C (stressful stimulus) cyclically for 20 min. Pulse rate and blood pressure rose significantly (P less than 0.01) during the stressful stimulus, but remained unaffected by the control stimulus. Rate of transient lower esophageal sphincter relaxations/30 min [median (interquartile range)] was similar before and during control stimulus, 4 (2.7-5.0) and 3 (2.0-4.5), respectively, whereas it was markedly inhibited during the stressful stimulus [from 5 (3.7-6.0) to 2 (1.0-2.0); P less than 0.05 vs control stimulus]. Rate of reflux episodes/30 min was also similar before and during control stimulus, 1 (0-1.2) and 1 (1.0-2.2), but fell consistently during the stressful stimulus [from 2 (0-3.2) to 1 (0-2.0); P less than 0.05 vs control stimulus]. Percentage of transient lower esophageal sphincter relaxations accompanied by a reflux episode was unaffected by stress as was basal lower esophageal sphincter pressure. It is concluded that cold stress decreases the postprandial rate of transient lower esophageal sphincter relaxations and reflux episodes in healthy humans.

The Effect of Acute Stress on Esophageal Motility and Gastroesophageal Reflux in Healthy Humans

“…A previous study showed that cold stress decreases the postprandial rate of transient LES relaxations and reflux episodes in healthy humans. 13 The findings of the present study failed to demonstrate this inhibitory effect of stress on gastroesophageal reflux. Although we expected the increase of reflux episodes and gastroesophageal reflux by acute stress, gastroesophageal reflux parameters were not significantly changed by acute stress.…”

“…A few studies regarding the effect of stress on esophageal motility and gastroesophageal reflux have shown controversial results. [11][12][13] Diverse models to induce psychological stress have been used in healthy volunteer studies. To induce acute stress, validated dichotomous listening has been commonly used.…”

The role of excessive esophageal acid exposure in patients with gastroesophageal reflux disease

“…Acid reflux episodes that occur during nighttime sleep periods are totally confined to periods of arousal, which may last for up to 10 s [9,23]. Stress from cold has also been shown to reduce the frequency of transient LES relaxations [24] and it has been found that, in dogs, spontaneous transient LES relaxation is completely suppressed by general anesthesia [25].…”

The effect of psychological stress on symptom severity and perception in patients with gastro-oesophageal reflux

“…However, while the application of psychological relaxation techniques has led to significant reductions in reported heartburn and duration of oesophageal acid exposure [7], clinical evidence for a decisive direct relationship between stress and GOR is still rather uncertain, with results reporting both an increase and decrease in GOR symptomatology during periods of stress [3,[8][9][10][11][12]. An indirect relationship between stress and GOR is also suggested.…”

“…For example, previous research has often involved very small sample sizes [11,12]. Investigators frequently used physical or purely cognitive stressors [3,8,11,12], even though more valid ones such as interview scenarios have been shown to increase oesophageal contractions [20].…”