Impaired Upper Esophageal Sphincter Reflexes in Patients With Supraesophageal Reflux Disease

Abstract

Background & Aims Normal responses of the upper esophageal sphincter (UES) and esophageal body to liquid reflux events prevent esophagopharyngeal reflux and its complications, but abnormal responses have not been characterized. We investigated whether patients with supra-esophageal reflux disease (SERD) have impaired UES and esophageal body responses to simulated reflux events. Methods We performed a prospective study of 25 patients with SERD (19–82 y old, 13 female) and complaints of regurgitation and supra-esophageal manifestations of reflux. We also included 10 patients with gastroesophageal reflux disease (GERD; 32–60 y old, 7 female) without troublesome regurgitation and supra-esophageal symptoms and 24 healthy asymptomatic individuals (controls; 19–49 y old, 13 female). UES and esophageal body pressure responses, along with luminal distribution of infusate during esophageal rapid and slow infusion of air or liquid, were monitored by concurrent high-resolution manometry and intraluminal impedance. Results A significantly smaller proportion of patients with SERD had UES contractile reflexes in response to slow esophageal infusion of acid than controls or patients with GERD. Only patients with SERD had abnormal UES relaxation responses to rapid distension with saline. Diminished esophageal peristaltic contractions resulted in esophageal stasis in patients with GERD or SERD. Conclusions Patients with SERD and complaints of regurgitation have impaired UES and esophageal responses to simulated liquid reflux events. These patterns could predispose them to esophagopharyngeal reflux.

Effects of Esophageal Acidification on Troublesome Symptoms: An Approach to Characterize True Acid GERD in Dysphagic Neonates

“…The remaining percentage of ascending AREs are associated with symptoms, and may be explained by ineffective, delayed or malfunctioning aerodigestive reflexes in which prolonged and more proximal exposure of the esophagus to refluxed acid may be activating visceral, autonomic and sensory aerodigestive pathways (44, 51, 53, 54). Other explanations may include varying volume of the refluxate and/or sleep state (1, 19, 44, 53–55). …”

The effect of body position on esophageal reflexes in cats: a possible mechanism of SIDS?

“…One might hypothesize that a better way to prevent supra-esophageal reflux is to increase secondary peristalsis and/or the esophago-UES contractile reflex rather than to increase EPSR. However, studies indicate that esophageal acid exposure in humans with reflux disease ( 28 ) and acute esophageal acid exposure in experimental animals ( 29 ) are both associated with increased reflex relaxation of the UES and a decrease in the sensitivity of the esophago-UES contractile reflex. In addition, gastro-esophageal reflux in humans is associated with a decrease in secondary peristalsis and an increase in non-peristaltic esophageal contractions ( 19 , 28 ).…”

Otolaryngologic Manifestations of Gastroesophageal Reflux

“…It is neither sensitive nor specific for GERD, however, and has no role in routine usage of diagnosing GERD [2••]. There are recent studies which suggest that abnormal esophagopharyngeal reflexes may be involved with extraesophageal reflux [36], but manometry should not be considered part of routine clinical evaluation at this time.…”